July 2021

Comment

JabSeeker

By Margaret Simons

The Royal Exhibition Building COVID-19 vaccination centre. © Darrian Traynor / Getty Images

The disordered national vaccine rollout reveals systemic flaws in our politics

I had been watching news reports of funeral pyres in India and talking to my London-based sister about how the numbers were going up again in England. Driven by fear and frustration, in early June I posted a tweet directed at my colleagues in the Canberra Press Gallery.

I asked them to take us inside government decision-making processes. It was clear the vaccine rollout was faltering, and there was inertia on agreeing to fund a purpose-built quarantine system. I asked: “Are we witnessing an inability to work together (we know some relationships are toxic), lack of administrative competence, ideological reasons, something else or all of the above?” Several journalists responded – mostly in private – and from them I gained insight: not into government decision-making processes but into the unprecedented difficulties of finding out why our government behaves as it does. One of the main justifications for the press gallery is the personal relationships the journalists can form, together with the conventions and understandings around background briefings. When it works, we find out how our politicians are thinking, and the how and why of decision-making.

But it isn’t working anymore. Ministers don’t talk. There are information “drops” to preferred journalists, chiefly from News Corp, but otherwise the flow of information is ever more tightly controlled. And so, at a time of existential threat, we know we are in trouble but we don’t know all the reasons why.

It is sometimes possible, my colleagues told me, to “crawl under the fence” and gain insight by speaking to the community of public health experts who advise government. “That takes you part of the way there, but not to the heart,” I was told.

As for what Health Minister Greg Hunt is saying to Prime Minister Scott Morrison, or who else Morrison listens to and what he is thinking, we have no reliable monitor. So, I tried to crawl under the fence.

We know a fair bit about government decision-making in the early months of the pandemic, thanks to Guardian Australia journalist Katharine Murphy’s Quarterly Essay, published last September. A vital part of Australia’s success in suppressing COVID-19 was that Morrison listened to the advice of the chief medical officer and closed our borders. That, together with lockdowns, is what made our trajectory better than that of the United States, the United Kingdom and most of Europe.

But those countries are leaping ahead of us in rolling out vaccination. And we now seem likely to tumble from the brink of our COVID-19 success.

What Murphy described as a hiatus in political tribalism at the beginning of the pandemic is over. A leading public health expert told me that what worried him most about our current condition are the systemic flaws it reveals in our politics, and in our country. There is a lack of national empathy, he said – state to state and Commonwealth to state. More worrying, there is a lack of common sense.

The cliché “we are all in this together” is also an epidemiological literal reality. One state’s outbreak, if it gets away, will soon be a national tragedy. Which makes the sparring over each state’s public health response “just mind-bogglingly shallow, even from a self-interested point of view”, in the words of the same public health expert.

Over the past 12 months, all states have adopted a zero-tolerance policy for COVID-19 spread in the community. All states use some combination of masks and restrictions on movement to control outbreaks. If Victoria is likely to lock down a little faster than New South Wales, it is also the case that since the disastrous second wave, its outbreaks have been more quickly controlled. Meanwhile, the NSW approach, which has paid off so far, comes with higher risks.

But the only way out of this whack-a-mole game is the vaccine rollout, and that has been botched. What Morrison once saw as a component of another winning election campaign is now a drag on his popularity. And part of the shallow sparring is that the government’s enemies can hardly hide their glee.

The numbers and haphazard progress of vaccine rollout – the targets adopted only to be dropped, the problems with distribution, and the particular failings in aged and disability care – hardly need restating. The number of vaccinations has started to lift, largely thanks to the scare of the Victorian outbreak, but at the time of writing we are about 98th in the world in terms of doses administered per head of population – well below the average, behind comparable countries such as the UK and the US, and also behind Romania, Latvia and Greece.

We know some of the reasons why. There were problems with vaccine procurement and supply. There is vaccine hesitancy, made worse by the rare clotting side effect of the AstraZeneca vaccine, which no government could have foreseen. But the inexplicable part of the story is that in those blessed few spring and summer months when it was possible to believe the worst was behind us, we failed to act with urgency. The prime minister told us it was not a race, but it was.

The public health experts agree that the virus will win in the end. It will get in. The only question is whether by then we will be sufficiently defended against it. So why are we here?

In the depths of a crisis, it is easy to puzzle over how attitudes to public health responses split along political lines. Surely, people say, it’s just a matter of following science. But public health in a pandemic means moving ahead of the science – being prepared to act early and hard, even when your evidence is incomplete. Partly for that reason, the experts do not always agree. In Australia, their differences of opinion are amplified by our increasingly partisan media.

At a deeper level, public health has always been inescapably political. It is about systems rather than the heroic surgeons and mind-bending innovations featured in most medical journalism. Public health sits at the intersection of individual responsibility and collective action, and at the meeting point of scientific evidence and political response. It has always been at the heart of our understanding of what it means to be part of a society.

All the big improvements in human wellbeing have been public health stories. First, dating from the Middle Ages to our own time, there was quarantine, involving community and sometimes government action to control plagues such as typhus, cholera, smallpox and the Black Death. It was accepted that curtailing individual liberties was justified in the interests of the wider public.

In the 19th century came the “the great sanitary awakening”: the identification of filth as a cause and carrier of disease, leading to an investment in sewerage and water supply systems, as well as for the disposal of waste. Sanitation implied big government and more taxes, to fund the necessary infrastructure. Then came publicly funded health systems, including subsidised vaccination programs.

With this history in mind, it is easier to understand why those who emphasise individual liberty, responsibility, effort and reward over the demands of the collective are more likely to be hostile to the demands of public health.

For this reason perhaps we should be grateful, bizarrely, that our current prime minister is a shape shifter, as Murphy describes him, not merely or even chiefly an ideologue. Having closed our borders, Morrison was initially more reluctant to adopt the public health mantra of “go hard, go early” when it came to lockdowns. Our federal system, so often seen as a weakness, came into its own. The states pushed the federal government to act faster, and the modelling has since confirmed that this was key. Another week or two, and we might well have been in the same position as the UK. But Morrison, to give him credit, did shift.

It is also a fortunate accident of history that we have competent premiers in all states. All of them listen and act on medical advice. All of them – across the political divide – accept the central role of government.

It could easily be otherwise. Imagine if Campbell Newman was still the premier of Queensland, or Jeff Kennett was still scything through the public service in Victoria.

But when it came to the vaccine rollout, Morrison seems to have returned to ideological type, or narrow political advantage. The decision-making is opaque, but, best as can be determined, he wanted to claim the success of vaccine rollout for his government. He wanted to sideline the states. He set about making GPs the centre of the rollout rather than state-run mass vaccination centres. The federal government contracted the delivery of vaccines in aged and disability care to private providers, rather than funding the states to do the job.

Things quickly went wrong. There were three reasons: supply, vaccine hesitancy and a lack of necessary urgency. ABC medical journalist Dr Norman Swan, informed by sources with knowledge of the negotiations with Pfizer, has described supply issues as partly the legacy of “breathtaking” incompetence – an unwillingness or inability to move fast, together with trying to “nickel and dime” the pharmaceutical companies over price.

Others disagree. A clinician who has knowledge of the process points out to me that decisions had to be made before anyone knew which, if any, of the vaccines then in development would work. Australia lacked the ability to make the new mRNA vaccines, but nevertheless a “bold and wise” decision was made to fund the local manufacture of the AstraZeneca vaccine. The government decided to buy 20 million doses of the Pfizer vaccine, but predictably it proved hard to land doses reliably on our shores. Forty million doses of the Novavax vaccine were purchased, but delivery has been continually delayed.

With the benefit of hindsight, the government should also have purchased the Moderna vaccine, and more of Pfizer. Nevertheless, the leading public health expert whom I spoke to said we now have vaccines “that are close to 100 per cent effective at preventing severe disease, even considering the new virus variants. That is because of government decisions, and that means that they weren’t, on balance, terrible decisions.” Thanks to the local manufacture of AstraZeneca, we are also able to export vaccine to our region.

It was the rollout process that faltered. There was at first no public information campaign to counter vaccine hesitancy. The logistics of efficient distribution to GPs defeated the government, and the private providers dawdled through the business of vaccinating the elderly and the disabled. The young weren’t even in the picture.

We were told that this was all okay, because it wasn’t a race. Because so far we had done well. Because there were no funeral pyres in our streets. The complacency and the stubbornness came from the top down.

Now, we have shifted again. The states have largely taken over, getting as many people injected as possible, including in mass centres. This has led to inconsistencies from state to state and clinic to clinic on who gets what vaccine. Supply issues continue, but before too long both Novavax and Moderna, and additional Pfizer, will likely be available. Meanwhile, the numbers of doses already delivered is climbing.

But the systemic weaknesses in our nationhood and our politics remain.

In the middle of 2019, John Blaxland from the Australian National University’s Strategic and Defence Studies Centre published what he described as a geostrategic analysis of Australia’s strengths, weaknesses, opportunities and threats. While he hadn’t included a pandemic among the “spectrum of potentially existential matters” that the nation faced, two years later his works stands up well as a tool for analysing Australia’s pandemic response.

Our strengths, Blaxland wrote, included that we were an island nation with no disputed borders. Then there were our abundant natural resources, strong economy, political stability including the rule of law, high levels of education and multiculturalism. As for the weaknesses, Blaxland identified our vulnerabilities to international supply chains. Australia, he said, had limited sovereign capacity to respond to extended crises or war.

He moved on to what may now prove to be our fatal weakness. Australia had a complacency about our place in the world that had “allowed an indulgent domestic political narcissism to fester. Politicians bicker and repeatedly change course, with short-term political cycles driving the agenda rather than inter-generational priorities. In the ‘lucky country’, abounding with natural resources, there has been room for mediocrity in politics.”

We have seen all that play out over the past 18 months – the luck of our borders, the adaptability of the population, the political stability. But now also the complacency, the lack of awareness of our true position in the world, and the internecine bickering.

Perhaps we will continue to be lucky, and perhaps Morrison will be lucky too. By the end of the year the political damage of the flawed rollout may be fading.

Or we might be living in the last few weeks of cloud-cuckoo-land. We might have already squandered our initial advantage, and with it our luck.

How foolish we might feel, looking back.

Margaret Simons

Margaret Simons is an author, journalist and journalism academic. She has written numerous books, articles and essays, including the Quarterly Essay Cry Me a River: The Tragedy of the Murray–Darling Basin.

@MargaretSimons

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