Pearls and Irritations

At a press conference about the vaccine rollout in December, Health Minister Greg Hunt said, “our goal is to under-promise and over-deliver”. Over January and February, the rollout was mapped out for us. However, the problems that soon developed were not a case of ‘the best-laid plans’ going awry but more like a case of ‘no plans at all’! It was inevitable that what was promised would not be delivered.

Supplies were barely dribbling in

Despite the lauded contracts, the government eventually realised delivery dates and quantities of both vaccines were either not known or were not guaranteed. With Pfizer we learnt – after it seems the government had learnt to its surprise – that the doses would not be arriving in a few large batches (e.g. millions), but rather in regular relatively small shipments of about 100,000 doses a week.

The good news is that at least it seems these small batches have been arriving in Australia on a reliable basis since the end of February. The bad news is that with this slow delivery rate there could not Pfizer vaccines soon enough to vaccinate those in groups 1a and 1b, as we thought we were promised (see Part 1).

The priority table given in Part 1 shows over 16 million doses were needed for the 1a and 1b groups. At 100,000 doses delivered a week, it would be almost six months, to the end of August, before that many Pfizer would have arrived.

For group 1a alone, 1.4 million doses, or 14 weeks’ worth of Pfizer were needed.

The government thus had to transition to using AstraZeneca for the bulk of the vaccine rollout for the top priority groups. Many of the frontline workers, together with the elderly, the sick and indigenous who were at most risk, would miss out on Pfizer and be switched to the lower efficacy AstraZeneca and its 12 weeks between doses. The risk of outbreaks from quarantine and in aged care increased as a result.

As it was, the transition to AstraZeneca wasn’t easily achieved.

At the end of February the government was banking on delivery of a big order of AstraZeneca from Europe as well as the millions of doses – up to 50 million – soon to be bursting out of the CSL laboratory in Melbourne.

In the meantime, vaccination hubs and centres were being set up around the country to receive the copious quantities of doses from the government for injecting into the waiting arms of the public. Some GPs and clinics spent tens of thousands of dollars getting ready to vaccinate hundreds, if not thousands, of people per week.

The latest plan for Australia that we know of is the Vaccine Roadmap dated 14 March 2021 from the Department of Health. It includes a very useful graph, not picked up by the mainstream media, which shows what the government had planned for 2021 i.e. the rollout ending in December.

In the graph, cumulative data for the vaccine doses to be delivered are stacked on top of each other for each month. The heights of the bars can be unstacked and used to estimate the number of new doses expected to be available each month for each vaccine. Following is a graph of these predicted monthly deliveries. (Novavax data are not included, pending its approval for use.)

From the March roadmap, we see that AstraZeneca was to become the main vaccine for the most at-risk groups. It was estimated there would be enough doses of the AstraZeneca, and Pfizer if used, for 1a by end of March and 1b by end of May. The roadmap showed that AstraZeneca would continue to be used for group 2a until July-August, meaning everyone aged 50 and over would have been vaccinated, mainly using AstraZeneca. From then, while there was predicted to be plenty of AstraZeneca continuing, there was also plenty of Pfizer becoming available too, but after most of those aged 50 or more had been vaccinated!

Importantly, this graph clearly shows that at mid-March, under the government’s plan well before the blood clot scare, Pfizer was already destined for the arms of the young and healthy, albeit in the last third of the year. However, much of the roadmap would soon be outdated in regard to AstraZeneca.

Delivery issues soon appeared. About 3 million doses from Europe would not be arriving, while the local AstraZeneca production in Melbourne, that the PM announced would be available “within weeks”, was nowhere in sight.

Heads were scratched about the CSL doses – “where the hell were they?”.

The clear indication that usable deliveries from CSL were weeks behind schedule materialised on 7 April when the PM called on the EU to supply the outstanding 3 million doses. Clearly, the government was panicking because it was well behind in the rollout and anxious to obtain more vaccine doses quickly, albeit from the unhelpful Europeans.

Thus, during March the government did not have nearly as much of the AstraZeneca as they had anticipated. Deliveries could not be made to vaccination centres in sufficient quantities. It was reported in the media that many clinics were only receiving 50 doses a week.

The following table illustrates the shortfall. It is based on two sets of data. The “expected” doses are from the government’s roadmap published on 14 March. The “supplied” is from the COVID-19 in Australia statistical website.

Sources: Expected. Supplied.

By the end of May, the Pfizer deliveries were matching expectations, once it was announced the doses would arrive in weekly batches; the shortfall by end of May was only 0.1 million doses. However, AstraZeneca deliveries, mainly to be produced locally by CSL, were estimated to be 6.6 million doses behind as we headed into June.

The following graph clearly shows how the actual supplies fell well below expectations for AstraZeneca.

Priority groups were reprioritised

The federal government’s forecasting, project management and understanding of contracts proved to be deplorable.

By the end of March, they had hoped to have administered 4 million doses. However, only 2.3 million were received from producers. Worse still, only 0.7 million of those doses had been administered. In theory, given the actual supply, the government could have vaccinated most group 1a members with two doses of Pfizer by the end of April. But that certainly did not happen.

The federal government made the bizarre decision of not giving the most critical group the best vaccine first. There is only one source of the virus – overseas arrivals, thus the high efficacy Pfizer, with just three weeks between doses, should have gone to frontline quarantine and healthcare workers first. If they get infected, the virus can end up in the community, with an outbreak on our hands. Yet we heard that many had not been vaccinated or were being ‘forced’ to accept the AstraZeneca option, which requires a 12-week waiting period for the second critical dose.

It seemed no longer important to give the better vaccine to the top priority groups, that the elderly, the chronically ill and the indigenous communities were no longer deemed to be critical cohorts, nor the disabled. We learned about shocking rollout problems with aged care residents and staff.

Even before the blood clot issue surfaced in early April, the government was flustered. There were two conflicting problems. Demand problems in the overall community were uneven and showed that uptake was very sluggish, meaning herd immunity targets were looking problematic. Supply problems meant that with pockets of high demand around the country there were not enough doses available to be sent to those clinics that had patients lining up.

Here we note how the blood clot decision in April led the PM to dramatically announce a recalibration of the rollout. The New Daily reported: “Completing a major backflip from the initial rollout, the Pfizer vaccine will now be almost entirely restricted to those under 50, with older people to only receive AstraZeneca.”

However, the 14 March roadmap indicates that the urgent recalibration had already been in place, well before the PM’s ‘remorseful’ announcement!

As the plan changed so did the language used by our decision-makers.

As far back as February, there were indications the government was aware of resistance to AstraZeneca. Statements like “both vaccines are equally effective in preventing hospitalisation and death” were shortened to “all of the vaccines are equally effective.” An example of the Health Minister using this misleading shortened statement can be found here.

Based on originally published efficacy rates, everything else being equal in infectious situations, AstraZeneca is not as effective as Pfizer in preventing mild to moderately severe Covid illness, including long Covid (which might affect up to one-third of victims). And many people wanted to have their vaccination completed within three weeks, not three months.

Our senior health officials could have corrected the Minister’s statement, but maybe they too had started to believe that to encourage people to accept AstraZeneca it is acceptable to make statements such as “there is no evidence of a material difference between these two vaccines”.

Had our politicians and health officials become so desperate that they needed to use the tactic of tweaking accuracy in order to get people lining up at vaccination centres so that the looming fiasco would not be as bad?

Many Australians understand efficacy and risk, and that long Covid is something they want to avoid. People realise that if ‘community immunity’ is low then it is imperative that one’s ‘personal immunity’ needs to be as high as possible. Inaccurate statements and claims make many lose confidence in the messages sent. We don’t know of any survey data, but even before the blood clot announcement, the proportion of Australians who only wanted Pfizer would have been significant, and a major reason for apparent vaccine hesitancy and the lower-than-hoped-for uptake.

The government continued to battle the ever-growing embarrassment of the rollout.

While the PM blamed the EU for shortages, predictably federal ministers turned to blaming the states for the slow rollout.

Meanwhile, the emerging blood clot problems with AstraZeneca reached a tipping point. By early April the decision was made not to recommend the AstraZeneca for under 50s. The fit and healthy young would be offered Pfizer. The blood clot risk is small, even for those under 50, but was high enough for the science to indicate the recommendation.

The government and health officials thus presented us with the mystery then as to why Pfizer is best for those aged under 50 and is (or was) best for those aged over 80 but is not best (or at least not preferred) for those aged in between, 50 to 80 years! And from June 17, make that 60 to 80 years.

This came about, though, because the government had not ordered enough Pfizer, so what supplies it was to receive now had to be “quarantined” for those under 50, meaning anyone older had to have AstraZeneca or nothing.

With insufficient uptake from groups 1b, vaccinations were opened up for group 2a in order to have more throughput at the vaccine centres. The blood clot problem issue with AstraZeneca, though, meant vaccine hesitancy had inevitably grown with those 50 and over, although they were now eligible to be vaccinated.

Not being honest and transparent with the public is not the way to achieve a high uptake.

For a vaccine described as “entirely voluntary” by the Health Minister, the language to have more people queuing up for vaccines became more persuasive, if not more coercive and threatening. For example, those who want to hold off for Pfizer might hear the blunt news (or threat) that if they don’t want AstraZeneca now they might have to wait until 2022 to be vaccinated.

The Covid hotline and vaccine booking service are far from helpful. Ask a question about the two vaccines on offer and you are told bluntly “the vaccines are safe”. Ask anything else such as what they mean by “safe” or any difference in their safety or effectiveness and you get the same four-word answer. They emphatically declare that anyone 50 or over without a special exemption can only have AstraZeneca. They advise you to speak with your GP, but we hear that many GPs do not provide the vaccine and are no better informed than the media.

Four Corners summarised the vaccination problems on 24 May in an episode entitled Australia’s COVID vaccine rollout: What went wrong?

In Part 3 we look at the vaccination numbers in early June, the time of an outbreak in Victoria and the appearance of a new variant, both of which would severely question the way the rollout is heading.

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