May 27, 2021

Federal politics

Roll out the babble

By Russell Marks
Image of Brendan Murphy, Greg Hunt and Scott Morrison

Department of Health secretary Dr Brendan Murphy, Minister for Health Greg Hunt and Prime Minister Scott Morrison. © AAP Image / Mick Tsikas

Vaccination logistics are complex, but the government’s failure is in communications

Is Australia being immunised against COVID-19, or isn’t it? It’s a question that’s surprisingly difficult to answer. Australia’s vaccination rollout, which is being managed by the federal government, has itself become politicised. Those instinctively critical of Coalition governments, or of bureaucracy, have by now convinced themselves the rollout has been mismanaged: that Australia’s continuing COVID-luck owes much to its border closures and low-ish population density, and nothing at all to the second-rate politicians who share its luck. That’s one of Labor’s main messages at the moment, and Monday’s Four Corners provided plenty of confirmation.

On the other hand, when I navigated my way to the federal health department’s online “Vaccine Eligibility Checker” tool this week, I learnt that I’m eligible for the Pfizer-BioNTech vaccine (brand name “Cominarty”) – because I’m under 50 and I have a chronic inflammatory condition – and that I could make an appointment for the first jab as early as the following day. My mother has received her first dose, and my 95-year-old grandmother got hers last night. That doesn’t feel much like mismanagement.

Are we being unnecessarily critical of what is, after all, a remarkably complex logistical exercise? As COVID-19 spread from Wuhan throughout China, Asia and then the world in January last year, infectious disease scientists had never succeeded in creating a coronavirus vaccine that was safe and effective for humans. That was despite the 2003 SARS outbreak that killed at least 774 people, the MERS coronavirus that’s so far killed more than 900 people across at least three outbreaks, and indeed the common cold, which in about 15 per cent of cases is caused by one of four coronavirus variants. Since Edward Jenner created the first modern vaccine for smallpox in 1796 – he took its name from the Latin for cowpox, which was the vaccine’s active agent – vaccines against all manner of infectious disease from influenza to polio have been a major success story of the scientific revolution. But no successful vaccine for anything had been developed in a timeline shorter than several years. In February 2020, as the world’s laboratories dropped everything and joined what’s been called the “gold rush” for the COVID-19 vaccine, the World Health Organization warned us not to expect one for at least 18 months.

The fact that a variety of vaccines were in fact being deployed as early as December was a kind of scientific miracle. As we know, the Morrison government backed a horse that was ultimately scratched: the vaccine being developed by researchers at the University of Queensland. (It remains in development, but when the other horses are bolting, “in development” means stable-bound and lame.) Plenty are asking why the Morrison government bet so much on UQ. Health Minister Greg Hunt’s explanation is that, at the time decisions had to be made, during the second half of last year, there was much that couldn’t be known. Would global distribution be interrupted by a kind of “vaccine nationalism” whereby governments in countries where successful vaccines were developed would prioritise their own populations and damn the world? The risk was real. For months last year, Europe and the United States blocked efforts at the World Trade Organization to have intellectual property for COVID-19 vaccines waived, and it wasn’t until earlier this month – more than 100 days into Joe Biden’s new presidency – that the US’s Trumpian position on IP was reversed.

No doubt the Morrison government’s thinking also reflected its own instincts. Australia is among a number of rich countries that copped international criticism for having reserved too many doses by the end of last year. Despite accounting for fewer than 1 per cent of global COVID-19 cases, Australia, Canada and Japan had collectively secured more than one-eighth of the world’s total number of premarket vaccine purchase commitments by mid-November. Had the UQ vaccine worked, it’s not difficult to imagine the Morrison government implementing the kind of “vaccine nationalism” to which it was worried other countries might have resorted.

Another cause of what some call “delay” in Australia’s vaccine rollout was the regulatory insistence that any vaccine that is administered to Australians is both effective and safe. Given the head-spinning speed with which the vaccines were developed and clinically trialled, “delay” seems radically the wrong word. The Therapeutic Goods Administration – responsible for assessing the safety and efficacy of all new drugs for the Australian market – approved the Oxford-AstraZeneca vaccine on February 16, about a month and a half after Britain did. (Britain was then reporting more than 50,000 new cases every day, and was in its third month of lockdown. Daily new cases in Australia numbered fewer than 40 and were trending down.) The following month, reports of serious blood clots associated with the AstraZeneca vaccine led most countries – despite the very small risk – to halt or restrict its rollout. Unlike many other countries, though, Australia had only one other option: Cominarty, which the TGA had approved on January 25. On April 9, the Australian Technical Advisory Group on Immunisation’s COVID-19 Working Group advised Hunt to limit the AstraZeneca vaccine to people over 50, for whom COVID-19 itself presents a much greater risk.

Many remain frustrated at what they see is a slower-than-necessary rollout. At the time of writing, nearly 3.7 million doses of either of the two available vaccines have been administered to Australians, most of whom fit into the “phase 1a” or “phase 1b” categories. Regular stories report that even among these categories, vaccination rates seem almost unbelievably slow. At current rates, the necessary 45 million doses won’t be fully administered until the end of 2023 (though rates will surely increase as distribution improves, and as different vaccines become available – such as that produced by Moderna, which is currently pending TGA approval). But it’s one thing to demand that everyone is vaccinated, stat. It’s quite another to manage the logistics of doing so in a country still beset by the tyranny of distance. Still, tens of thousands of people are receiving injections every day. For every 100 Australians, 14 doses have already been administered. That’s much slower than in Britain, Europe, the US and China, where the urgency is much greater. But it’s also faster than in South Korea, New Zealand, Japan, Iran and South Africa, and about equal with India.

Logistics is only one part of a project this large and this urgent. Winter is coming, and with it the significant probability of a third wave. There’s every likelihood that Australia’s luck will end at some point. The worst-case scenario is that one of the nastier variants takes root here while the population is still waiting for vaccination. Melbourne is now bracing itself for what it desperately hopes is not another major outbreak.

The other major element of a project like this is communications. This is the prime minister’s area of professional expertise, so it should be an area of competence. But the government has done almost everything badly. Morrison declared an impossibly ambitious target in February, when he promised that all 25 million Australians would be vaccinated by October, before backtracking just weeks later and then again last month. The federal government has made surprisingly little information available, even when one goes actively searching for it. State governments say they’re getting no more information than anyone else, despite bearing responsibility for hospitals and most health services. It’s not hard to imagine something like the “bear with us” messaging the state premiers became so adept at last year, combined with a simple campaign emphasising the public health goal of herd immunity, the steps involved for individuals, and the need for patience and understanding. Instead, the key federal players – the PM, Hunt and the health department’s secretary, Dr Brendan Murphy – seem defensive and cantankerous.

More than once, journalists and even the public have been criticised for their failures to behave as the government would have preferred. As Murphy explained to the ABC’s Adam Harvey, the vaccine booking system only failed because “people didn’t heed our warning to wait until more GPs came online”. And the reason there is now some hesitation about vaccination among the population is due, he says, to “sensationalist media reports” that have emphasised risk factors – such as blood clots – in “a not particularly balanced way”. As a departmental secretary, Murphy doesn’t need to possess the smoothness of an elected politician. But he was likely expressing frustrations that have been expressed consistently in high-level planning.

In reality, Morrison got off scot-free last year by refusing to assume anything more than a tokenistic role in quarantining border-crossers and returned travellers. Australia’s Constitution is very clear that its framers intended quarantine to be a Commonwealth responsibility, but Morrison was content to let the states and territories manage things – and to cop the blame for failures, such as those that sparked Victoria’s second wave. Almost unbelievably, Australia remains overly reliant on hotels for its quarantine requirements, and the federal budget this month found no additional funds despite the prospect that greater numbers will return from Europe. This year, Morrison’s main task is to coordinate the nation’s vaccination program. That means logistics, but it also means comms. Yet the most prevalent feeling among Australians now is confusion.

Comms failures have, surprisingly, become a persistent feature of Morrison’s government. On bushfires, workplace assaults and now vaccinations, it has never demonstrated competence at even basic messaging. As a result, it has never built up any of the reserve of goodwill that most state governments were able to garner last year. It’s long been observed now that the people attracted to work in Liberal ministers’ offices are motivated much more by fighting culture wars against the ABC and the universities than they are by the pragmatic need to deliver good and effective government. The extent to which the personnel problem is feeding into the government’s general communications failures is unclear, though it can’t be helping.

Running beneath the uncertainties created by the comms strategy is an even larger uncertainty that’s well beyond the government’s – or anyone’s – control. Will the vaccines work? The best evidence to date suggests that the TGA-approved vaccines will significantly reduce the risk that COVID-19 – including its variants – can be caught or passed on. But they’re unlikely to entirely eliminate the risk. And nobody can yet know for how long each vaccine provides immunity. Will the future require all of us to get annual COVID-19 jabs, just as we’re now supposed to get flu vaccines at the beginning of each winter? Will COVID-19 injections need to be administered even more frequently? What proportion of the population can miss their vaccines without affecting herd immunity? Is herd immunity even possible? There can’t be answers to these questions for some time yet. As such, the world is effectively participating in a gigantic clinical trial. Can we hope for eradication? Or will we eventually see COVID-19 as a kind of superflu which, like influenza, inevitably produces its own annual death toll?

Russell Marks

Russell Marks is a lawyer and an adjunct research fellow at La Trobe University. He is the author of Crime and Punishment: Offenders and Victims in a Broken Justice System (Black Inc., 2015). 

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