Vaccine rollout: the value or otherwise of a ‘vaccination certificate’. Part 3

Mar 1, 2021

Those who are vaccinated can still become infectious. Therefore proof of vaccination might not be sufficient for international travel as it does not guarantee a person is infection free. A ‘vaccination certificate’ can be wrongly used as a proxy for ‘not infectious’.

Vaccination and international travel

There are two problems regarding travel. One is as individuals – not to get sick from Covid. The other is as a society – to minimise community infection. Vaccination doesn’t reduce either problem to zero.

It would be safe to travel to NZ and some other countries at the moment, whether vaccinated or not, because they have like Australia eliminated the virus from the community. Yet, they too don’t have herd immunity. Bizarrely, right now one probably has a higher risk of picking up the virus while in hotel quarantine than travelling to certain countries.

There is a risk in travelling to countries with high infection numbers after vaccination because a vaccine does not guarantee immunity. For those who receive the Pfizer vaccine, 5% would be susceptible to Covid, but no one would know if they were in the unprotected 5% or in the protected 95%! Well, not until they got sick. With the AstraZeneca, no one would know if they were in the unprotected 38%.

Governments have to manage country-wide risk. As explained in Part 2, under the government’s planned vaccine program, if everyone took it up, at least 5.5 million in Australia, or about 22%, will still be at risk of becoming ill from the coronavirus.

Furthermore, those who are vaccinated and are protected can still become infectious, though we have no data about the proportion. Thus, vaccinated Australians travelling overseas could be infectious and hence their destination country might want to check; might insist on quarantine. Similarly international arrivals, whether Australians or foreigners, even though vaccinated, can still be infectious. NZ insists on 14-day quarantine for Australians even though we have no known community infections; NZ travellers can currently land here quarantine free.

Being infectious is the problem, especially with some new strains. Thus proof of vaccination might not be sufficient for international travel as it does not guarantee a person is infection free. A ‘vaccination certificate’ can be wrongly used as a proxy for ‘not infectious’. The WHO has warned that vaccinated holiday makers could still spread Covid.

Hence, swabbing for recent infection and 14-day quarantining may have to continue for the ‘foreseeable future’, here and in other countries.

For international travel e-vaccination certificates have been mooted. This Lonely Planet article examines whether people will need a vaccine to fly and notes that Qantas might insist on evidence of vaccination to board international flights.

However, a ‘vaccination certificate’ might not be worth the ‘paper it could be written on’. Eventually some countries will deem each other safe for travel bubbles, with no quarantine at either end.

At home: fewer lockdowns but perhaps a society divided by vaccine status

The really good news is that soon, once the frontline workers have been vaccinated with Pfizer, quarantine breakouts and community transmissions should drop dramatically. And that should mean the end of lockdowns and closed state borders. The proviso, though, is that those workers don’t become complacent and relax their standards, and that Australians don’t become overconfident and feel they are ‘uninfectable’ and ‘uninfectious’.

A wise person might say we need to always act as if we have the virus and that we can all catch the virus.

Will Australians have to be identifiable as being vaccinated or not?

The federal government has already flagged the use of vaccination certificates. That anyone who receives a vaccine will have it officially registered as a record should they need it. The Government Services Minister said: “Australians need to have that record depending on state public health orders, but especially when travelling and when borders open up again.”

This SBS link notes that the Australian government will be making vaccination certificates available via smartphone apps and hard copy. It also notes that the “vaccine certificates may be needed to gain entry to certain high-risk venues such as aged care facilities”.

Some aged care establishments already require proof of flu vaccination before entry, even though (practically) all staff and residents had had the flu vaccine. This shows a conundrum with vaccines, that those who are vaccinated against a disease might still be fearful about catching it.

Other uses of the Covid certificate have been noted, including entry to hospitals and crossing state borders (should there be another closure).

The SBS link also notes:

Last month the NSW government floated the idea that vaccination certificates may be required to enter pubs, cafes and restaurants in the state.

This headline about Israel’s Green Pass sums up the division that might lie ahead:

“Israel’s Covid-19 vaccination certificate opens fast track to normal life. People with the so-called ‘Green Pass’ will get access to gyms, hotels and theatres.”

Thus, normal life returns for some, but not for the unvaccinated.

Certificates are likely to note which vaccine was used and might make some certificates more valuable than others based on efficacy rates: gold standard (e.g. Pfizer with claimed 95% efficacy), silver (e.g. Novavax with 89%) and bronze (e.g. AstraZeneca with 62%)? Will aged care and other establishments insist on a gold standard vaccine before you can visit? Will travel insurance be priced accordingly?

All Australian governments, businesses and organisations will have to be careful about how a Covid ‘vaccination certificate’ is to be used.

Here are some concerns for the unvaccinated:

  • Allowed on internal flights? On any form of public transport?
  • Barred from seeing elderly parents while vaccinated siblings can?
  • Restrictions on entering hospitals, having operations?
  • Restrictions in schools, universities and workplaces?
  • Refused international travel insurance?

And apart from public discrimination, will there be a rise in private discrimination? Many Australians are Covid cautious. Will friends start to shun each other on the basis of vaccination status?

Take-up problems ahead!

There are pointers to the vaccination take-up rate being well short of the government’s target.

The government is not providing any choice. Those in the lower vulnerability categories are being ‘forced’ to have the AstraZeneca vaccine, or none at all. One can sympathise with those who would not want that option given its failed immunity rate (38%) is more than seven times the failed immunity rate of Pfizer (5%).

Is there a significant ethical question in ‘forcing’ many Australians to have an inferior vaccine?

On 22 February, Deutsche Welle, the German broadcaster, recently ran this report: AstraZeneca vaccine remains unpopular in Germany. That there was no freedom of choice for many Germans and widespread scepticism about the effectiveness of the vaccine.

The authorities in Germany are trying to remove doubt that it could be an inferior vaccine.

In Australia, our Health Minister will have to watch that he does not distort the truth to try to do likewise. On 15 February he was quoted as saying: “And as Professor Murphy said, all of the vaccines are equally effective.” On the efficacy results, they are clearly far from equal. We can put his statement down to a slip of the tongue, or maybe not understanding what Professor Murphy actually said.

The take-up rate for the whole program was always going to be problematic. This article in The Conversation is not definitive but it may indicate the magnitude of the problem of people not wanting to be vaccinated. In May 2020 some 65% of those surveyed said they would accept the Covid-19 vaccine, and 27% were uncertain. In November the indication for had dropped to 56% and the uncertain risen to 31%. Recent survey data show about a quarter of Australians are still hesitant to have the coronavirus vaccine.

There will always be medical, religious and other reasons why people would decline.

As doubt about AstraZeneca continues, we can assume the take-up will decline further.

Even though they are using the valued Pfizer option, it seems in Israel after a very high take-up, fewer and fewer are now being vaccinated. They have no real explanation as to why people are not turning up for injections.

The vaccine rollout for Australia is described as a massive task. However, it is not necessary to rush. The plan needs to be rejigged to restore trust and overcome people’s fears and suspicions. Otherwise we may fall well short of a sustainable level of immunity.

Under the government’s current plan, more than 5 million children (under 16) might not be offered vaccinations. If the take-up of AstraZeneca is only 70%, we estimate that more than 6 million adults would have immunity risks. That gives at least 11 million in Australia, or about 43%, who are not vaccinated or at risk of becoming ill from the coronavirus.”

It is predictable that many Australians will refuse the AstraZeneca vaccine (and insist on the Pfizer or equivalent), not because it is dangerous, but because it is less effective.

However, it is also predictable that the federal government will not admit that they have ‘stuffed up’ by committing to an inferior product, one they proudly announced is being made locally.

To quote from The Conversation article given earlier:

“Australia must not squander this opportunity by proceeding with the rollout of a vaccine that’s already been proven ineffective against one of the world’s most concerning variants. Rather, we must use high-efficacy vaccines to build herd immunity, and secure Australia’s long-term future.”

Recently, we reported that Australia was towards the top of the leaderboard for handling Covid-19.

Without our dithering PM, Australia would be on top of Covid-19 leaderboard

Bizarrely, in 12 months’ time we might be at the bottom of the list in terms of overall immunity coverage.

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