Risk aversion has put the nation in Covid-19 danger

Scott Morrison has accepted responsibility and apologised for the government’s poor performance on Australia’s vaccination rollout. His concession ties the federal government closer to what is a worsening situation with Covid-19 in three states. Thursday’s apology followed frustration by the Prime Minister on Wednesday at how concerns about rare side effects of the AstraZeneca vaccine had been allowed to undermine the government’s vaccination plans. Mr Morrison’s apology is a calculated political circuit-breaker but it adds pressure on the federal government to deliver.

With additional supplies of the Pfizer vaccine now available, it is reasonable to assume a high level of coverage can be achieved before the end of the year. It is therefore too early to conclude that problems with the rollout to date inevitably will undermine the federal government’s chances of re-election sometime next year. Nonetheless, a better performance is critical as the economic impact of the lockdowns in Greater Sydney, Melbourne and South Australia begins to bite. On Thursday Queensland shut its borders to NSW, plunging the nation back into a cycle of lockups and lockouts.

There still is hope that infection numbers will turn around as lockdown measures take effect. But a sobering reality is that once the Delta variant of the virus has established a foothold in other countries it has proved impossible to shake. Given the trend in NSW where daily infections remain above 100, with almost half of those circulating in the community before they are diagnosed, a King Canute moment with the Delta variant may well be on its way. Improving rates of vaccination therefore must be the priority.

Mr Morrison’s frustration with the Australian Technical Advisory Group on Immunisation correctly identifies the point at which the vaccine program ran off the rails. This was in April when Pfizer was recommended for under-50s because of a rare blood-clotting side effect from AstraZeneca. Mr Morrison has been criticised for what was perceived as an attack on ATAGI, despite saying he had great respect for its work and advice. But what the issue highlights is a lack of sophistication generally within government and the media in dealing with complex matters of risk. The government was not bound by a directive from ATAGI. The media, in particular, must accept its role in boosting vaccine hesitancy and undermining the rollout with over-hyped reporting of potential side effects from the AstraZeneca vaccine without taking account of the bigger context.

The same misunderstandings are evident today. Mr Morrison effectively criticised ATAGI for not changing its advice as the risk profile changed with more cases of Covid-19 infection in the community. A review of the ATAGI advice shows it has been updated constantly as risk factors have changed. Despite perceptions to the contrary, ATAGI has never said the use of AstraZeneca for people under 50 should be outlawed. In its initial advice concerning the rare blood clots on April 8, ATAGI recommended that Pfizer was preferred over AstraZeneca for adults under 50. But it said the AstraZeneca vaccine was highly effective at reducing the risk of death or severe disease from Covid-19 across all adult age groups. ATAGI acknowledged in April that the AstraZeneca vaccine was the only option for many Australians since the global availability of alternative vaccines was highly constrained. “ATAGI recognises this safety concern will likely impact on confidence in being vaccinated with AstraZeneca vaccine in all age groups,” the group said. It warned that “until the government can increase supply of Covid-19 vaccines other than AstraZeneca, overall coverage under Australia’s Covid-19 vaccine program will likely be reduced”.

“In the short term, delays in vaccine uptake increase the vulnerability of the Australian population to outbreaks of Covid-19 and the attendant risk of death and serious morbidity, especially among older Australians,” ATAGI explicitly said. “Covid-19 vaccine AstraZeneca can be used in adults aged under 50 years where the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits.”

With Australia performing well on keeping Covid-19 infections low, on June 17 ATAGI lifted the age that it recommended the Pfizer vaccine be used from 50 to 60. But on July 13, as outbreaks of the Delta variant began to surface in the community, ATAGI revised its recommendation. It said: “In the context of a Covid-19 outbreak where the supply of (Pfizer) is constrained, adults younger than 60 years old who do not have immediate access to Pfizer should reassess the benefits to them and their contacts from being vaccinated with Covid-19 vaccine AstraZeneca, versus the rare risk of a serious side effect.” ATAGI had done exactly what Mr Morrison had called for it to do: to reconsider its advice as risk changed.

It is now clear that the potential dangers outlined by ATAGI in its initial advice, including increased vaccine hesitancy and heightened vulnerability in the event of an outbreak, have been realised. The latest data shows there have been five confirmed deaths from blood clotting reported in Australia from more than 6.1 million AstraZeneca doses.

Complacency and a belief in lockdowns have undermined the nation’s pandemic response. For this the blame must be shared by politicians across party lines and jurisdictions, medical advisers and a media unwilling or unable to see the bigger picture.