Australia won’t be the first to get Covid vaccine but we must try to be best at delivery

An effective and safe vaccine is only half the solution to beating COVID-19 and getting back to normal.

A safe and effective vaccine is necessary, but it’s not sufficient.

Fresh out of the isolation bubble, Scott Morrison made a rhetorical shift on Australia’s COVID-19 vaccine status. For months the Prime Minister’s message was we were at the “front of the queue” to get access to a vaccine.

As news came that Britain had granted emergency approval for the Pfizer BioNTech candidate, Morrison said on Thursday we would now have a “front-row seat” to the rollout. Our authorities would be armed with more data from the British experience and would adjust strategy if required.

As the pandemic pressure has eased here, subsequent waves of infection are putting health systems under immense strain in Europe, Asia and, of course, the Americas. On balance, authorities in Britain have moved before trial results are in to begin vaccinating the most vulnerable, particularly the aged.

We have breathing space, but the big challenges will soon be on us. Australia has secured 134.8 million doses of four vaccine candidates and access to the international COVAX facility. A safe and effective vaccine is necessary, but it’s not sufficient.

Perhaps more important is how well vaccines are mass-produced, delivered, stored, prioritised, accepted, administered and monitored post-jab. Are our strategy and systems up to it? “Vaccines don’t save lives,” Yale University professor of public health A. David Paltiel told The New York Times. “Vaccination programs save lives.”

Federal Health Department secretary Brendan Murphy has described the coming vaccine rollout as a “logistics challenge the likes of which we have never seen before”. For instance, Pfizer’s product requires storage at temperatures as low as -80C.

Canberra has responsibility for purchasing and transporting vaccines to storage and administration sites within each state and territory; it will track and trace all doses through the system.

All Australians who want to be vaccinated will get it free. States and territories will be responsible for ensuring a qualified and trained workforce can support delivery of local plans, in tandem with peak bodies and training providers. With an approved vaccine likely to require two jabs, weeks apart, this rollout will take months.

What will be the vaccine take-up rate? Rates of childhood immunisation here are at record highs compared with the rest of the world. According to federal Health Minister Greg Hunt, 94.9 per cent of all children aged five years and 97.03 per cent of Aboriginal and Torres Strait Islander children aged five years were fully vaccinated.

Adults are another matter. Surveys suggest about 75 per cent of Australians would take an approved vaccine. Men are more hesitant than women. According to the Melbourne Institute, there is a great diversity behind the headline number, with age, confidence in government and education major factors. “To put this in perspective,” authors Marco Castillo and Ragan Petrie wrote in October, “a 65-year-old, university degree-holding Australian who is satisfied with the government’s economic policies is 32 percentage points (92 versus 60) more likely to take a vaccine than a younger Australian with less than a university degree and not satisfied with government economic policies.”

Professor Brendan Murphy has described the coming vaccine rollout as a “logistics challenge the likes of which we have never seen before”. Picture: Getty

As well, there is no agreement among experts on precisely what percentage of the population needs to be immune for the coronavirus to be suppressed; estimates range from 43 per cent to 90 per cent. Vaccine experts say more data will be needed on potential candidates and the benefits, harms, virus shedding, infectivity of those vaccinated and dur­ation of protection to allow model­lers to predict potential herd immunity.

Hunt said on Thursday the first approval from the Therapeutic Goods Administration is likely to be in late January.

Vaccinations are on track to begin in March but could come earlier if TGA approval is speedier and vaccines in stock. Demand will outstrip supply, so there will be angst if the strategy is not properly communicated

According to health officials, the first vaccine doses will be given to frontline healthcare workers, carers of vulnerable people and, if safety data supports, vulnerable people. But what about workers in prisons or at airports, where risks are increased?

“While it’s important to vaccinate frontline health workers, what about those working in quarantining facilities, or meat workers which due to the nature of their work are at high risk?” Oxford University professor of health economics Philip Clarke tells Inquirer. “A more comprehensive occupational risk-based prioritisation strategy is needed.”

Then we get to areas where the system will need to lift its game: record-keeping and surveillance. Last month the Australian Technical Advisory Group on Immunisation said: “It will be critical that all vaccine doses administered be recorded on the Australian Immunisation Register within a short time frame after vaccination, irrespective of the priority group targeted.”

ATAGI noted only about 40 per cent of influenza vaccine doses recently distributed have been entered on to the national register, and data on the use or non-use of the remaining doses are absent. At present, not all vaccine providers make a record on the register.

On Thursday, Hunt introduced a bill to ensure all vaccination providers report to the national register any vaccines given. “These changes will ensure that every Australian can access their vaccine history through this safe and secure register and support the administration of COVID-19 vac­cines and other lifesaving vac­cines, including those against the flu and meningococcal,” he said.

As well, Murphy has flagged a for more active surveillance after immunisation, to check whether a person has had an adverse reaction, rather than the TGA’s passive monitoring that puts the onus on patients and doctors. Remember, these vaccines will have come to the public at lightning speed, TGA screening and worldwide peer review notwithstanding.

“We’re very concerned about that issue because, early on, there won’t be the 10 years of trials that normally would come with a new vaccine,” Murphy told a Senate committee in October. “We would likely use a program where you send a text message to someone two days after a vaccine and ask them to report any adverse effects.”

ATAGI says it is critical we have broad “system readiness”. Our public health infrastructure has been robust, but it will be tested again and again.

And so will the Morrison government’s vaccine messaging, as we step up next year from the relative safety of the front row into the immunisation frontline.