Pearls and Irritations

Calling something as poorly designed as Australia’s Covid vaccination system ‘a rollout’ gives wheels a bad name. The failure to manage effectively the identification of priority groups for coronavirus vaccination, and to deliver vaccines to them, has to date been an awful failure of public administration.

The Federal Government’s approach to prioritising population groups for covid vaccines can be characterised as one that has favoured and promoted whichever group has newly-acquired media coverage while having no compunction whatsoever about whether higher priorities have been met. One of the clearest and most shameful examples of this procedure relates to staff in residential aged care facilities.

When vaccines first became available, aged care residents and staff were identified as one of the first priorities. They were in 1a. On 7 January 2021, the Prime Minister announced that 4 million Australians would be vaccinated by the end of March 2021; this would include all residents and staff of residential aged care facilities.

The importance of the allocation of a priority was that vaccines were in short supply. And because there was very little coronavirus in Australia at the time, no one demurred about the decision to look after the elderly and their institutional carers first. In the unlikely event that the virus did appear it was the elderly who would be most vulnerable to serious illness and death. And society owed a debt of gratitude to the grandparent generation.

Surprising though it may seem in a country that has generally been well-served by agencies that collect and use quantitative information, the absence of good data on this matter has been an ongoing problem. Despite the fact that the aged care workforce had been given a top priority back in January, in the first week of June the responsible Federal Ministers, Greg Hunt and Richard Colbeck, admitted that they were not able to say what number of aged care staff had received zero, 1 and 2 covid vaccinations. Greg Hunt, Minister for Health, apologised to Parliament for an incorrect report on the matter. He confirmed that 20 aged care facilities had not yet been visited as part of the national vaccination rollout.

There are over 2,600 residential aged care facilities in Australia. Around 240,000 people are employed in direct aged care, of whom about 150,000 are in that residential sector. The other 90,000 direct care workers are employed in community aged care. Over 85% of this quarter of a million are female.

The wisdom of making aged care staff one of the highest priorities for vaccines had been tragically illustrated by the second wave in Victoria. Of the 730 covid-related deaths in that State in the period from early July to late October 2020, 655 were of patients in residential aged care.

Some of the particular fragilities of the aged care system had also become clear. Because of low wage rates and the casualisation of staff, it was not uncommon for individuals to work in more than one facility, thus increasing the risk of infection spreading from place to place. And the care system could be compromised by the temporary loss of staff to illness.

Another problem was that, unlike the situation with previously required vaccinations, the status of staff with respect to covid inoculation was not linked to payroll. Furthermore, it was not until June 2021 that operators were required to report each week to a central agency (the Federal Health Department) on the covid immunisation status of their staff.

Some of these issues were compounded by confusion or overlap between federal and state jurisdictions. The Victorian government moved to ensure that staff of the facilities it managed could no longer work across multiple sites. The Federal Government, which is responsible for the regulation of the majority of aged care homes, scrapped that policy in November 2020. It was replaced with a set of principles that would see that “ideally” (sic), an aged care worker would be limited to working at a single aged care site. The federal government reinstated the regulation in June 2021.

At the end of that month, two-thirds of staff working in aged care homes across Australia were still not fully vaccinated.

Finally, something stirred. On 2 July National Cabinet agreed to adopt the “strong advice” from the Australian Health Protection Principal Committee (AHPPC) to make vaccination against covid mandatory for all staff of residential aged care facilities. The new requirement comes into operation on 17 September 2021. All staff will be required to have had at least a first dose of a COVID-19 vaccine.

This action will be underwritten by a grant program to help the centres and, through them, their individual staff members. Eligible payments will help with travel to the nearest vaccination site and cover for lost wages. The Federal Government will oversee compliance by all centres.

Lt General John Frewen is now Co-ordinator General of the National Covid Vaccine Taskforce. Given this pivoting of leadership, it should be permissible to observe that if military precision and logistics had been applied from the very beginning, the promised commitment to aged care workers could have been acquitted in the six weeks to the end of March.

The mandatory vaccination of aged care staff must be completed on time, with a high level of competence and effectiveness. In some respects, it will be harder than it would have been in February and March. There is now much greater competition between population groups to be prioritised, due in particular to the situation in NSW. Some might even dare to whisper that the elderly ought to have no higher priority than young adults – the mixers and spreaders – and Aboriginal and Torres Strait Islander people.

We want leadership. And no more unmet goals or unreached horizons. Because it is now clear and alarming that the priorities set eighteen months ago are no longer fit for purpose.