Rethinking Australia’s Covid vaccine rollout: beware a two-tier system. Part 1

Feb 25, 2021

If our rollout proceeds, using two different vaccines, we might create a society of suspicion and division: vaccinated v non-vaccinated, Pfizer v AstraZeneca. Most other countries need to mass vaccinate now but Australia doesn’t. We should forget AstraZeneca and wait for higher efficacy vaccines to avoid having lower overall immunity than those other countries.

Many countries desperately need the Covid-19 vaccines. Except for frontline workers and the vulnerable, Australia does not have such urgency. Yet the federal government is rushing Australia’s rollout. The plan needs to be modified to use only high efficacy vaccines, like Pfizer, to ensure we have enough immunity and avoid a society divided on the basis of vaccine status.

Vaccinations in Australia started on Monday, 22 February. The Conversation explains Australia’s strategy:

“Australia has secured access to 20 million doses of the Pfizer/BioNTech vaccine, 53.8 million doses of the Oxford/AstraZeneca vaccine, and 51 million doses of the Novavax vaccine. All of these require two doses for maximum effectiveness.

The federal government plans to begin vaccinating groups at high risk with the Pfizer/BioNTech vaccine, then use the AstraZeneca vaccine for the remainder of the population.

The Novavax vaccine may be used at a later date.”

The use of AstraZeneca is rushed and flawed

Since September, the federal government has widely and confidently promoted Australia’s access to vaccines. One senses the PM is pinning his hopes on the rollout as a crowning achievement and one that which will deflect attention from arguments about federal government shirking responsibility for quarantine.

With an efficacy rate of 95%, the early roll out of the Pfizer vaccine to frontline quarantine and health workers, combined with a continuation of our quarantine system, should quickly solve the problems of community outbreaks.

Provided complacency does not set in with these workers, Australia may soon see the end of lockdowns and closed state borders, if not the end of closed international borders.

Speed is not the issue. Australia could have everyone vaccinated tomorrow and it would make little difference to our infection rate. We currently only have a few dozen cases in Australia.

A major issue with the rollout is that the AstraZeneca vaccine to be offered to most Australians has an efficacy rate quoted as low as 62%. This means the failed immunity rate for AstraZeneca (38%) is more than seven times the failed immunity rate of Pfizer (5%).

This raises concerns about whether we can reach widespread immunity, about when we will be able to open up to the rest of the world and whether divisions based on people’s vaccinations status will appear.

It is not clear when the Pfizer vaccines will be available as the doses are arriving in batches, presumably over coming months. On the other hand, on February 12 the Prime Minister proudly announced that the AstraZeneca vaccine would be made by CSL in Melbourne, and be available “in a matter of weeks”.

Thus, it is possible that both vaccines may be rolled out to different risk groups at the same time. However, as we explain later, it would be understandable if some or many Australians did not want to take up the AstraZeneca option: its use at all needs to be queried. Australia does not have an urgent need to use it, and instead the rollout can be delayed so that all can be vaccinated using Pfizer or equivalent.

A major concern is that if the rollout proceeds as planned, using two different vaccines, we might create an Australian society of suspicion and division: vaccinated v non-vaccinated, Pfizer v AstraZeneca. Could we end up with a situation where one sibling is allowed into an aged care facility to see their parent, while another sibling isn’t? Could some people be barred from hospitals or aircraft?

Even with the highly rated vaccines many uncertainties remain, meaning that quarantining and international travel restrictions will remain in some form or other for the foreseeable future.

No vaccine has ever reached 100% effectiveness. Problems will continue until we vaccinate extensively worldwide with high efficacy vaccines and we reach the ‘herd immunity’ stage, where the virus has been eliminated, if not eradicated. That means every country has to work quickly to conquer the virus to reduce the chance of dangerous new mutations.

The Covid vaccines work for the countries that need it

The Covid problems in some of the worst hit countries, including the US, UK and Israel, are well documented. They began vaccinating some weeks ago: US and Israel with the Pfizer and Moderna vaccines, UK with AstraZeneca and Pfizer. Other countries have also started vaccinating. Here is a very useful link to vaccinations by country.

Israel is the world leader. Nearly a third of its citizens have been vaccinated with two doses and nearly a half have received one dose. Since its rollout started, Israel’s daily new Covid cases, number of active cases and daily deaths have clearly slowed. The same pattern has been repeated in the UK, the US and elsewhere. The vaccines appear to be working.

But not all countries are so lucky. The New York Times on 9 February reported: “In Bolivia, bodies are piling up at homes and on the streets again.”

Many countries couldn’t jump to the front of the vaccine queue or afford the most efficacious options such as Pfizer or Moderna, or perhaps any vaccine at all. Doses of the Russian Sputnik V are now being given in Bolivia but the rollout will be slow. Many developing countries, however, have no rollout at all; they might not yet have anything to inject.

There have been and are many warnings about vaccine nationalism and how not helping the less-privileged countries combat and control the virus could prolong the pandemic worldwide.

The race is on … vaccines vs variants. The global response will determine the winner

Thus in countries where the virus remains out of control, more dangerous mutations may develop, with the potential of making their way through the borders of well-off countries and rendering their vaccination programs useless.

Australia’s superfluous AstraZeneca vaccines could be redirected to these countries, as even with a lower efficacy rate, it will still slow the virus’s progress. Further, given the propensity for mutations to develop, nobody is safe until everybody is safe.

Vaccines help, but not if you have no infections in the community

The chance of anyone in the community getting Covid in Australia is close to zero.

However, if Australia were to stop quarantining and open our international borders, Covid cases could explode. Our planned vaccination rollout would not be in time to prevent widespread illness and crises in our hospitals.

With the imminent vaccinating of our frontline workers and the continuation of our current prevention policies, the chance of anyone in the community getting Covid should reduce even further.

Australia’s tackling of Covid has been phenomenal. Most jurisdictions have gone for several months with zero or next to zero community cases. As I write (24/2/21), nationwide we have 65 active cases, with 51 overseas arrivals. NZ has 62 active cases, of which 51 are overseas arrivals. The US has 9.3 million active cases and the UK 1.7 million.

Australia does not have a Covid-19 problem that requires immediate mass vaccination using an inferior vaccine.

Since mid-October 2020 Australia has had only 1,538 Covid cases and five deaths. Of the cases in that period, 1,171 were infections in overseas arrivals, leaving just 367 confirmed locally acquired cases in four months.

If this pattern continued, over the next four months we would expect a similar number, meaning that the chance of a positive test in the community is about 367 in 25.5 million or 0.00144% or about 14.4 chances in a million. (The figure for NZ is even lower.)

The imminent rollout of frontline workers should reduce the risk further, provided our international arrivals remain controlled.

This emphasises that the US and the UK and most other countries have to mass vaccinate as soon as possible but that Australia and NZ don’t.

Our decision makers have to make sure that the mass rollout is done for the right reasons: we should not be vaccinating “just because we can” and we certainly should not be doing it for political reasons and we certainly should not continue knowing that one vaccine may be below the standard required.

The federal government has defined its priority list. The first group of 678,000 comprises frontline workers and aged care residents and staff. The second group of 6,139,000 targets the vulnerable, including the elderly and those with underlying medical conditions.

Between the two groups we have about 30% of the population covered. They could be given the Pfizer vaccine, assuming enough doses arrive in Australia.

It is not necessary to vaccinate the 70% of the rest of the community yet, given that we will have a strong quarantine system in place. An ethical question is whether anyone in Australia should be given the AstraZeneca vaccine with its lower effectivity?

A rethink of the rollout could lead to a much better outcome. In Part 2 we explain why Australia is unlikely to achieve herd immunity under the current plan.

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