Pearls and Irritations

It is important that all Australians be vaccinated against Covid-19, but they deserve to be able to choose the vaccine that best suits them. As the federal government’s rollout plan implodes, the good news is that it now seems likely that all Australians who want it will be able to have the higher efficacy Pfizer vaccine which the PM received last month.

A litany of disasters but we might end up OK!

With the vaccine rollout, we have a farce of NBN proportions.

Where to start with the dog’s breakfast that Scott Morrison, Greg Hunt and his senior health officials have created? Apart from the economic consequences, there are now four Covid disasters for which the federal government has responsibility:

• First is its failure to take charge of quarantining, for which it has responsibility under the Constitution,
• second is the several hundred aged care deaths in Commonwealth run facilities,
• third is the current vaccine rollout which was doomed once AstraZeneca was chosen as the main vaccine with its relatively low published efficacy rate of 62% in preventing Covid illness, compared to Pfizer with its 95%,
• and fourth is the Covid disaster quickly developing in PNG, which urgently needs Australia’s assistance.

But there is good news. One is that we have another 20 million Pfizer doses on order, due to arrive from October onwards. The other is that we now know Pfizer can be rolled out in more difficult situations as it can be kept at domestic freezer temperatures during transport. And there is indirect good news in the decision not to recommend the AstraZeneca for under 50s.

Australia will thus have 40 million doses of Pfizer, enough for 20 million of our population of 25.5 million. With the right decision-making from now on – combined with some patience from the Australian public – Australia and PNG can come out the other side in good shape.

Many countries desperately need Covid-19 vaccines, and those with lower efficacy rates, such as AstraZeneca, can help them. Australia does not have such urgency, despite the baying from those with business interests, amongst others. We have the luxury of time, wealth and zero community transmissions. And we have quarantining and border control systems that will continue to keep infections out of the community.

With the extra Pfizer doses on top of what we would have from AstraZeneca, we might in fact be able to immunise most people with their preferences by the end of 2021. Anyone who is happy to have the AstraZeneca vaccine should be given it as soon as possible; we have over 50 million doses on order. Those who are happy to wait for Pfizer should be allowed to do that. Assuming the Pfizer deliveries continue in a predictable way, there will be enough of both to go around.

It seems increasingly clear that Australia was unlikely to achieve herd immunity under the previous mix of vaccines because of the inferior efficacy of AstraZeneca, in which case opening up our international borders would have been questionable anyway. Adding an extra few months to roll out the extra Pfizer injections will provide a much higher level of community immunity, paving the way for reopening our borders.

There is urgency for those who are anxious to have a vaccine and for frontline workers. And there may be urgency given that winter is approaching. However, that can be mitigated by restricting arrivals from overseas, particularly from Covid hotspots, as NZ has by suspending flights from India.

There are predictions that millions will have to wait longer to be vaccinated despite the new Pfizer deal. But that does not make sense as, if we were previously on track to achieve our vaccination first does targets by October-December, surely an extra 20 million doses of Pfizer make it even more possible? It requires just three weeks between doses, not AstraZeneca’s three months.

So how do we extricate ourselves from the pending rollout disaster and come up with a winner?

Stop over-hyping, start admitting mistakes and being transparent

In early February The Age ran this feature: Morrison shows again he’s master of spin. It discusses the gushing drip-feed since August and “the Prime Minister’s talent for making 10 announcements when one might do”.

In the end the government over-promised and over-committed. As it continues to battle the ever-growing embarrassment of the rollout, it is digging a bigger and bigger hole for itself. Predictably federal ministers turned to blaming the states. The PM blamed the EU.

The PM, last week, promised more transparency and data. But very little is forthcoming: see The Pfizer vaccine is now crucial to Australia. Why the secrecy about how much we have?

NZ provides very detailed data on Covid infections and vaccinations. In Australia, however, there is a dearth of useful published data. Some numbers – that may or may not be useful or meaningful – are only forthcoming in ‘garbled’ form via TV from the reassuring mouths of the PM, the Health Minister and their two main advisors.

The government’s decision-making might be based on political outcomes (an impending election) rather than the health of the nation. It seems to have confidence that the private sector can deliver.

The Coalition tore apart the ALP’s NBN ‘fibre to the home’ model and replaced it with a mix of technologies and connection options. We might never know the true costs of the bungled broadband rollout, characterised by contracting and sub-contracting out the work to private firms. The vaccine rollout has similar features, as can be seen from this recent article in the Guardian. It explains how lack of transparency and opaque deals with private consultants, logistics companies and healthcare contractors have added to ‘layers of confusion’ over rollout while sending unknown millions of dollars in their direction.

But there is also bizarre ineptness, best illustrated by not giving the most important group the best vaccine first. Thus, Australians can only be infected if the virus escapes into the community, and there is only one source of the virus – overseas arrivals. Hence, it was imperative that frontline quarantine and health workers be vaccinated first, and with the most efficacious vaccine in Pfizer. Yet, from what we know, it seems Pfizer has been mainly rolled out by the federal government to many aged care residents and workers. In the meantime, we learn that many frontline quarantine and healthcare workers have either not been vaccinated or are being ‘forced’ to accept the AstraZeneca option, which requires a waiting period of 12 weeks for the second dose.

The CEO of AstraZeneca, who lives in Sydney, provided the government with the opportunity to produce a vaccine here, by CSL in Melbourne. While it provided us with logistical independence, that might now mean an overcommitment. The excess AstraZeneca produced in Australia should be offered to PNG.

Meanwhile, according to The Guardian, frustrated experts say Australia could already be producing mRNA Covid vaccines if it had acted earlier. The government needs to take steps to ensure we are not reliant on overseas supplies for such vaccines in the future.

We now have the opportunity to roll out Pfizer, rather than AstraZeneca. The world is not going to open up any time soon. A major complication is that those who are vaccinated can still be infectious, but we don’t yet know what rate and to what degree.

If Australians are denied international travel for a few more months, so be it if it means we are a healthier nation by inoculating everyone possible with the best possible vaccine and we achieve herd immunity. With some luck, this could all be done by the end of 2021.

Offer Pfizer to those who want it

Instead of unrolling, our vaccination plan is unravelling. We are seeing more and more headlines like this: ‘There is no time left to waste. Our vaccine rollout is a disaster. Here’s how to fix it’. The authors write: “We need more doses of the high-efficacy vaccines like Pfizer and Moderna”.

The real mistake made by the government from the beginning was to rely on AstraZeneca in any substantial way.

The government had ordered enough to vaccinate 10 million of us using two doses of Pfizer and 15 million using two doses of AstraZeneca. There were other higher efficacy options as well.

NZ has purchased enough Pfizer vaccines for their entire population of five million. Their PM said, “the decision to make Pfizer the country’s primary vaccine provider was taken after it was shown to be about 95 per cent effective at preventing symptomatic infection”.

Australians need to ask why we are not all receiving the best Covid vaccines, like NZ, Israel, Singapore and the US? Will we go from being top of the list for handling the vaccine but end up towards the bottom of the list for vaccine rollout, with only a partially immune population?

Hong Kong is delaying its ordered shipments of the AstraZeneca vaccine and is “considering buying a new type of vaccine that may offer better protection”.

Australians need to be told which vaccine we are to be given. We should be offered a choice, even if it does mean a delay of a few months. For those willing, is a three-month wait for the Pfizer much different to the 12 weeks for the second dose of AstraZeneca?

There was plenty of early advice against AstraZeneca:

“The president of the Australian and New Zealand Society for Immunology, Prof Stephen Turner, told Nine media that Australia should halt the AstraZeneca vaccine rollout because it has ‘lower efficacy’. ‘You cannot rely on it to establish herd immunity,’ he said.”

Also here: “Herd immunity is the end game for the pandemic, but the AstraZeneca vaccine won’t get us there”.

In describing the rollout as an epic fail, former PM, Kevin Rudd, writes: “Early warnings that Australia should diversify its vaccine portfolio and avoid putting too many eggs in the AstraZeneca basket have been proven right.”

The blood clot risk of AstraZeneca is amazingly low and arguably not a good enough reason to reject it. The reason it should be rejected is that it is not as good as other options in providing immunity: Pfizer is the NBN equivalent of ‘fibre to the home’ while AstraZeneca is the NBN equivalent of ‘fibre to the node’.

We note that the data show that both AstraZeneca and Pfizer provide full immunity against hospitalisation and death. Rather, it is for mild to moderate cases and long Covid where Pfizer is far more effective.

Our vaccine rollout might be salvageable

There is no need for Covid haste in Australia. We have time to achieve the best.

With vaccine hesitancy a problem and a rollout based mainly around AstraZeneca, Australia would struggle to reach herd immunity. Now that more people can receive Pfizer this hesitancy might be overcome with people knowing that they will have higher protection through a remarkable vaccine.

Unless we intend to live under a mushroom, all of us will encounter infectious situations once international borders open up and infections are introduced into the community. That could be on public transport, at airports, in restaurants, at school or university, day-to-day shopping or at a gathering with friends. In infectious situations, with AstraZeneca, the risk of hospitalisation or death might be close to zero, but the risk of catching Covid will be somewhat higher than if vaccinated with Pfizer.

The federal government needs to transition to use only high efficacy vaccines. There are four major reasons:

– To ensure we reach herd immunity,

– to protect individuals from mild to moderate illness, and long-term Covid in particular,

– to avoid a society divided on the basis of vaccine status,

– to optimise international travel and economic performance.

The federal government can easily fix all these problems by offering Pfizer or equivalent to everyone who wants it. The greater transportability of Pfizer and the extra 20 million doses on order – assuming delivery comes through – point to this being achievable, and within a reasonable time frame.

It means we can all choose to have the same vaccine as our PM had.

In the meantime, our nearest neighbour, PNG, with a rampant infection rate that has to be defeated, desperately needs the millions of AstraZeneca doses which we will no longer need.

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