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.
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.
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.
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”.
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.
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.
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.
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.
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.
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
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.
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.
One case of Lambda was recorded in hotel quarantine in New South Wales in April.
Lambda has now been detected in more than 20 countries around the globe.
In June this year, the WHO designated it a “variant of interest”. This is due to mutations thought to affect the virus’ characteristics, such as how easily it’s transmitted. Though it’s not yet concerning enough for the WHO to deem it a “variant of concern”, such as Alpha or Delta.
Epidemiological evidence is still mounting as to the exact threat Lamda poses. So, at this stage more research is required to say for certain how its mutations impact transmission, its ability to evade protection from vaccines, and the severity of disease.
Preliminary evidence suggests Lambda has an easier time infecting our cells and is a bit better at dodging our immune systems. But vaccines should still do a good job against it.
Is Lambda more infectious? And can it escape vaccines?
What’s more, as many of the coronavirus vaccines currently available or in development are based on the spike protein, changes to the spike protein in new variants can impact vaccine effectiveness
Lambda contains multiple mutations to the spike protein.
One mutation (F490S) has already been associated with reduced susceptibility to antibodies generated in patients who had recovered from COVID. This means antibodies generated from being infected with the original Wuhan strain of COVID aren’t quite as effective at neutralising Lambda.
Another Lambda mutation (L452Q) is at the same position in the spike protein as a previously studied mutation found in the Delta variant (L452R). This mutation in Delta not only increases the ability of the virus to infect cells, but also promotes immune escape meaning the antibodies vaccines generate are less likely to recognise it.
Both mutations F490S and L452Q are in the “receptor binding domain”, which is the part of the spike protein that attaches to our cells.
Preliminary data on the Lambda spike protein suggests it has increased infectivity, meaning it’s more easily able to infect cells than the original Wuhan virus and the Alpha and Gamma variants. These early studies also suggest antibodies generated in people receiving the CoronaVac vaccine (developed by Chinese biotech Sinovac) were less potent at neutralising the spike protein of Lambda than they were the Wuhan, Alpha or Gamma variants.
It’s worth noting infectivity is not the same as being more infectious between people. There’s not enough evidence yet that Lambda is definitely more infectious, but the mutations it has suggest it’s possible.
A separate small study, also yet to be reviewed by the scientific community, suggests the L452Q mutation in the Lambda spike protein is responsible for its increased ability to infect cells. Like the L452R mutation in the Delta variant, this study suggests the L452Q mutation means Lambda may bind more easily to the “ACE2 receptor”, which is the gateway for SARS-CoV-2 to enter our cells.
This preliminary study suggests Lambda’s spike protein mutations reduce the ability of antibodies generated by both Pfizer and Moderna’s vaccines to neutralise the virus. Also, one mutation was shown to resist neutralisation by antibodies from antibody therapy to some extent.
However, these reductions were moderate. Also, neutralising antibodies are only one part of a protective immune response elicited by vaccination. Therefore, these studies conclude currently approved vaccines and antibody therapies can still protect against disease caused by Lambda.
Is it more severe?
A risk assessment released by Public Health England in July concedes there’s not yet enough information on Lambda to know whether infection increases the risk of severe disease.
The risk assessment also recommends ongoing surveillance in countries where both Lambda and Delta are present be implemented as a priority. The aim would be to find out whether Lambda is capable of out-competing Delta.
With ongoing high levels of transmission of the coronavirus, there’s a continued risk of new variants emerging. The Lambda variant again highlights the risk of these mutations increasing the ability of SARS-CoV-2 to infect cells or disrupt existing vaccines and antibody drugs.
The WHO will continue to study Lambda to determine whether it has the potential to become an emerging risk to global public health and a variant of concern.
Michelle Grattan, University of CanberraPfizer doses in NSW will be spaced out to enable more first jabs to be administered quickly, as the Berejiklian government on Friday declared the Sydney COVID crisis a “national emergency”.
But the plea by the state for Pfizer doses to be diverted to Sydney as part of a refocusing of the national vaccine program has fallen on deaf ears.
Scott Morrison indicated if any extra Pfizer supplies became available they would be directed to NSW – but he made clear there would be no change in the national vaccination program.
“Where there is a potential to put more vaccines into NSW, even beyond what we’re already doing, well, of course, we will seek to do that. But we are not going to disrupt the vaccination program around the rest of the country,” he said after a meeting of the national cabinet.
Vaccines are distributed on a population basis, although NSW was recently given a special allocation of 300,000 doses, half AstraZeneca and half Pfizer.
Morrison also said suppression was the key immediate means of stopping community transmission and getting on top of the outbreak that is concentrated in south western Sydney. “Suppression is the primary tool to achieve that, and vaccines can help that.”
Earlier, General JJ Frewen, who is in charge of the vaccine rollout, was dismissive of the suggestion supplies be diverted.
“Vaccines are only one part of a response to the outbreak like this,” Frewen told a Senate committee.
Other states made it clear they would not give up any of their Pfizer supplies.
Morrison said extending the time between Pfizer doses – normally three weeks – to six weeks was within the advice of The Australian Technical Advisory Group on Immunisation (ATAGI). This would be done in NSW vaccination clinics.
He also said there was “agreement amongst the national cabinet that we need to continue to lean in to AstraZeneca, particularly in NSW”.
Australian Medical Association President Dr Omar Khorshid on Friday called on ATAGI to review its advice on AstraZeneca in response to the growing risks posed by the outbreak of the Delta variant in NSW.
“As we don’t have enough Pfizer to use in a targeted rollout, the only option is AstraZeneca. It will save lives and help see life return to some normality in Greater Sydney,” Khorshid said.
ATAGI has preferred Pfizer for those under 60, although it recently qualified its advice in light of the Sydney outbreak.
As NSW on Friday reported 136 new cases in the 24 hours to 8pm Thursday, Victorian Premier Daniel Andrews said “Sydney is on fire with this virus and we need a ring of steel put around Sydney”.
But Morrison said that at national cabinet Berejiklian had spelled out “in very specific detail the extensive lockdown” the state had in place.
“There’s nothing light about the lockdown in NSW – in Sydney, I can assure you. My family are in it,” he said.
At her news conference on Friday morning, Berejiklian said Chief Health Officer Kerry Chant and her team “advised us that the situation that exists now in NSW, namely around south-western and now western Sydney suburbs, is regarded as a national emergency.”
She appealed for the vaccination strategy to be redirected to south western Sydney, particularly to younger people who had to perform essential work such as the production of food.
She said there was a very young population in the affected communities, “and we need at least more first doses of Pfizer.”
Meanwhile, figures given to the Senate COVID committee showed only 47.2% of residential aged care workers had had a first vaccine dose and 27.8% had received their second dose. Vaccination has been made mandatory by September for these workers.
I am, of course, talking about the Tokyo Olympic Games and the international roll-out of vaccines against COVID-19.
Australia has been in the top ten in the medal tally at every summer Olympics since 1992. It is projected to again be near the top in Tokyo – certainly on a per-capita basis.
But in the vaccination standings, we are near the bottom of the OECD league.
When it comes to COVID vaccines, Australia has had a shocker. With apologies to the late legendary sports broadcaster Norman May, no one would be exclaiming: “Gold! Gold to Australia! Gold!”
Things are not going swimmingly. If this were a 4×100 metre medley relay, our team would involve the backstroker jumping into the diving pool, the breaststroker veering into the wrong lane, the butterfly swimmer breaking, and the freestyle anchor swimmer sinking.
Unlike other competitor countries, the Australian government failed to buy a broad portfolio of vaccines. It bet on two options — one being developed by the University of Queensland, the other by Oxford University and AstraZeneca — that could be made in Australia. This has proven a mistake.
It didn’t ramp up its mRNA vaccine purchasing until very late in the game. Bypassing state governments, it thought it could rely on GPs to deliver the vaccines without paying them properly or appreciating they have limited capacity, do other important things and don’t always have the specialist freezers required to store mRNA vaccines.
Australia’s administrative state
Australians seemed to have been surprised by the incompetence of our vaccine purchasing strategy and roll-out. With the lockdowns in Sydney, Melbourne and now Adelaide exposing the folly of Prime Minister Scott Morrison’s declaration in March that vaccination “is not a race”, his approval rating has slumped to its lowest since the pandemic began.
We generally trust our governments — federal, state and local — to do most things reasonably well. Indeed, compared to the rest of the world the “administrative state” in Australia works incredibly well.
From getting a drivers’ licence to being treated in a public hospital, enrolling a child in school or obtaining government benefits and assistance, things tend to just “work”. Kind of like an Apple product.
Even in wealthy countries with excellent rule of law this is not always the case. Ask anyone who has gone to the Department of Motor Vehicles in a major US city.
Australia’s administrative state is built on the hard work and common sense of those who work in the public sector. It has a proud track record.
So why has the vaccination roll-out been so botched? Was it just bad luck? Or are there broader lessons?
More than just luck
Well, bad luck played a role.
The UQ vaccine did look promising, making it to phase 1 clinical trials before it was discovered it produced results falsely suggesting recipients had HIV. It is still in “redevelopment”.
AstraZeneca has been associated with a small risk of blood clotting, which has shaken public confidence, and led the governent’s health advisers to recommend it only for those those aged 60 or older.
This is why smart investors don’t put all their eggs in one — or two — baskets. They diversify.
There was a lot more to our vaccine bungles than bad luck. How things turned out depended in large part on what government did. To paraphrase an old golfing saying, the harder you work, the luckier you get.
There are three lessons from the vaccination debacle.
First, the public service is full of great people, but the capacity of government departments has been systematically downgraded over the past few decades.
Both sides of politics must share some of the blame. If we as citizens are appalled by the performance of a health official, then we have to look beyond the person to the office. How did he or she end up there?
Second, far too much of government at a federal level is seen through a purely partisan political lens.
States governments, which live or die largely on the quality of service delivery, are often much better in this regard. Sure, Victorian premier Dan Andrews and his NSW counterpart Gladys Berejiklian are good politicians. But their biggest political asset is their track record in delivering for their states.
Third, short-termism in government thinking is a big problem.
Short-term thinking dulls the powerful electoral incentives that (at least partly) drive politicians to perform. As any economist will tell you, people respond to incentives. But political incentives don’t seem to be working very well these days. If voters think short-term, so will politicians.
We don’t necessarily need to demand more of government. We should insist political leaders act as if they care about the future — of the country, and the planet — rather than just the next election.
Yes, this is a race
Make no mistake: Australia’s response to the pandemic is a competition.
It’s a competition for international investment, skilled migrants, tourists and students. It’s a competition to provide a supportive environment for business, a well-functioning environment for consumers, and a safe environment for citizens and visitors.
And we’re losing. Badly.
Perhaps watching the Olympics over the next couple of weeks will give our leaders a patriotic shot in the arm, and inspire them to give the rest of the vaccination race their best.
We are counting on them.
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.
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.
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.
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.
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.