Pearls and Irritations

While Australia embarks on third booster shots, the vaccination rate in PNG is less than 2 per cent. What does that say about being a good neighbour?

“The Therapeutic Goods Administration (TGA) has approved booster doses of the Pfizer vaccine for people aged 18 years and older, six months after their second dose.”

“In high-income countries, over 60 per cent of people have had at least one vaccine dose, compared to around 4 per cent in low- income countries.”

“Despite production forecasts of up to 12 billion doses being produced by the end of 2021, 92 low- and middle- income countries representing half of the global population — will have access to just 1.2 billion doses”

These three statements do not sit comfortably together. Can we explore how we might contribute to resolving the COVID-19 pandemic with countries in greatest need of help?

Don’t have time to read this? Watch Dr Mike Ryan from the World Health Organization (WHO) explain it in 57 seconds:

#COVID19 vaccines availability:
High income countries 1️⃣3️⃣3️⃣ 💉 per 1️⃣0⃣0⃣ 👫
Low income countries 4️⃣ 💉 per 1️⃣0⃣0⃣ 👫@DrMikeRyan speaks on some of the causes of this disparity.#VaccinEquity pic.twitter.com/cw3PAXOZjo

— World Health Organization (WHO) (@WHO) October 25, 2021

Australia’s roll out

While there is still work to be done, the vaccination program in Australia has undoubtedly been successful, with more than 86 per cent of us over 16 years old having had at least one dose. More effort is needed in various populations, including jurisdictions where there has been minimal COVID-19 outbreaks, and some Aboriginal and Torres Strait Islander communities.

In some cases, like the ACT, NSW and Victoria, single doses have going into more than nine out of 10 adults’ arms. Australia has among the highest vaccination rates in teenagers in the world.

Spreading our wings

For half the country, borders, offices, cafes, restaurants and even airports are reopening and a sense of relief and optimism for a “normal” Christmas is palpable. These are wonderful developments to be celebrated. People in the public health world have a lot to be proud of and an enormous amount of virus-caused disease and death has been prevented. Many, many people have worked tirelessly to get us to this point, while reminding us that “this thing ain’t over”. As we drop our guard, see more people, travel more, gather in larger crowds, so too will more of the virus spread.  But in a well-vaccinated population there will be far less illness and death.

But what about overseas travel? Us getting on planes, visitors arriving in Australia? What then?

Who’s for a boost?

We’ve more recently turned our attention to the issue of booster doses of the vaccine. There is lots of discussion to be had. On October 27, the Therapeutic Goods Administration (TGA) approved the use of the Pfizer vaccine (COMIRNATY), and on October 28 the Australian Technical Advisory Group on Immunisation (ATAGI) published its recommendations on the use of additional (booster) doses of COVID-19 vaccine.

First (and second) doses come first 

Let’s lock in one simple principle. Be it domestically or internationally, first and second doses are the most vital first line of defence in responding to the pandemic. Be it in lower vaccinated jurisdictions such as WA, SA, Queensland and the Northern Territory where reaching the large bulk of the community remains the highest priority. Even more so for Aboriginal and Torres Strait islander communities or communities with poor access to healthcare. But that is also very much the case for the rest of the world, and in particular low- and middle- income countries where health systems do not have the capacity to manage major outbreaks.

And remembering that COVID-19 is now a part of our world and will reach all parts of it — in time.

Vaccines supplies — how much is enough? 

The Australian government has purchased or ordered a total of 255.8 million doses direct from manufacturers, including those ordered for booster shots in 2022-23.  Excluding the dose swap/sharing arrangements with Singapore and the UK, we will have 126 million Pfizer, 25 million Moderna, 53.8 million AstraZeneca and 51 million Novavax COVID-19 vaccine doses

About 13 per cent of our population of around 25 million are under the age of 10, meaning we’ll be looking to vaccinate about 21.75 million people.  If we vaccinate 100 per cent of us, with three doses (allowing one booster each) that comes to a total of 65.25 million doses. Allowing for 10 per cent wastage level (expiry dates being reached before they are used), that takes our needs to 71.77 million doses. Even if we allow two booster doses each (and no one is recommending that — still lots of evidence to be gathered before that could be considered) it still takes out maximum possible use to fewer than 100 million doses.

In addition to this, the Australian government has pre-purchased 25 million doses for Australians through COVAX (of which it has already received 500,000).

Even without our COVAX doses, we now have two to three times the supply than we could possibly need up to the end of 2022.

Meanwhile, “56 countries who were effectively excluded from the global vaccine marketplace were not able to reach the target of vaccinating 10 per cent of their populations by the end of September and most of them in Africa. Even more countries are at risk of missing the 40 per cent target by the end of this year.” WHO)Director-General Dr Tedros Adhanom Ghebreyesus, October 13.

Among some of our own neighbours, things are dire. Vaccination rates (including those only single dosed) in Papua New Guinea are less than 2 per cent, Solomon Islands 17 per cent, Myanmar 20 per cent, Philippines 25 per cent, East Timor 39 per cent, Indonesia 41 per cent, Kiribati 44 per cent, and Tonga 47 per cent.

Two fundamental problems exist. The first is supply and access to the vaccine. The second is the capacity and infrastructure to administer the vaccine program. Australia is contributing on both counts.

In terms of the rich versus poor reach of vaccines the graph below tells the story.

So what are we doing to help ?

The Australian government has invested over $8 billion in our own national COVID-19 vaccine rollout. We have also invested more than $350 million in vaccine research and development.

On the international front, the Australian government has joined the COVAX Facility as part of a global effort to support rapid, fair and equitable access to COVID-19 vaccines. COVAX is a collaboration between CEPI, Gavi, the Vaccine Alliance, and the WHO with UNICEF. Being part of it enables us to buy vaccine doses for ourselves via the COVAX Facility as they become available.  We are part of the more wealthy 90 nations who put money on the table via COVAX.

A further 92 lower-income countries are eligible for support from it. Australia’s participation means COVAX can invest in different vaccines and support vaccine manufacturers.

So far Australia has committee $130 million to the Advance Market Commitment of COVAX, with a focus on Pacific Island and South-East Asian nations.

In addition, $623 million over three years is committed for the Regional Vaccine Access and Health Security Initiative — which is assisting our Pacific and South-East Asian neighbours to access and administer safe and effective COVID-19 vaccines. This includes $100 million for our Quad partnership with Japan, the US and India to deliver a billion doses to South-East Asia by the end of 2022.

As of October 28, Australian-shared doses numbered 5.9 million, with a commitment to share 60 million COVID-19 vaccine doses with the Indo-Pacific by the end of 2022. This is becoming more urgent and perhaps the government should see sharing doses as a race as well.

The shameful global vaccine apartheid in 10 images

There is also a strong case to be made that AstraZenca vaccine manufacturing (in Australia, by CSL) should not be discontinued. Instead ramping up production would help ensure equitable access to vaccines.

These commitments may well be influenced by regional politics and the desire to prevent China being seen as the benevolent neighbour who may wish to wield political influence in the future.  Perhaps the motivations are less important than meeting the immediate need.

The need to vaccinate the world is getting now urgent. As the virus spreads, particularly into new populations, there are increased risks of more mutations. And maybe worse than the Delta variant current running rampant. Apart from being the right thing to do, it is also in our interests to accelerate the rate of vaccination of the rest of the world.

How about one for one?

What about the idea that Australia commit to a “one for one” policy? For every booster dose that Australia plans to administer, we commit to making one dose available for another country. And not just those who we wish to influence — but through COVAX mechanism which goes to those most in need.

So if we are suggesting one (and maybe two) booster doses, committing to ensure we provide 20, (or 40) million doses to people without our resources and capacity?

Such a policy is easy to understand, is in our own interest and will boost our commitment to see the rest of the word come out of the pandemic more quickly that we might if we leave market forces to dominate.

So, the message is

1. Keep going at home; and
2. One for one for our mates, as defined by the rest of the world.

Looks like a pretty good foreign policy to us.