Unmasking the truth about the path to freedom
The road map out of lockdown is far from clear, but this is what we know for sure.
With 16 million Australians fighting the Delta strand in lockdown and hardship, the emotional and policy dilemma only becomes inescapable – the nation cannot live in this way yet it is doomed to suffer periodic lockdowns until the 70-80 per cent vaccination target is reached.
Australians face a grim four-month period until November. Personal trauma and economic pain will intensify. There is no sign of progress for NSW in its protracted lockdown. Victoria has entered its sixth lockdown. Southeast Queensland may get a reprieve this week.
Apprehension is deepening across the country. For many in lockdown each day resembles a reoccurring misery. The frustration arises from the lack of progress, the sense the Delta strand is outpacing our health resources. Politicians fight and medical experts pontificate. There is no immediate escape – but there is an escape.
Things will get better. This view is founded in science not just hope. The problem is that things may get worse before they get better. And when they get better the virus won’t be gone. The fight against Covid will merely take a new form with the public far better protected, in full vaccinated armour.
There are no certainties. But the best way to understand the coming trade-offs remains the pathway endorsed by national cabinet based on Doherty Institute modelling and Treasury analysis released this week.
Here are some relevant questions and answers.
Q: What vaccination rate delivers assured herd immunity?
A: As Professor Jodie McVernon from the Doherty Institute said, there is no “magic number”, no binary cut-off that delivers “life as normal”. This is not the way to think. Vaccination coverage is a continuum. Every person vaccinated helps to reduce transmission. Doherty modelling suggests having rates at 70-80 per cent means the need for long, stringent measures and lockdowns will be “substantially reduced”.
McVernon told Inquirer: “With Delta and the vaccines that we have we never get to this magic number where the reproduction number or transmission potential is one or less, meaning that outbreaks would not take off. But we can still significantly restrain the spread of the virus with vaccination. It is definitely our pathway out of the cycle of lockdown.”
The point is that all these options are suboptimal. That’s the reality. “The vaccines we have are good but no vaccines are perfect,” McVernon said.
How long before the 70-80 per cent double dose rates can be achieved?
Scott Morrison expects to reach 70 per cent later this year, perhaps by November. Program co-ordinator, Lieutenant General John Frewen said there was a “really good opportunity” to hit 70 per cent and even “potentially” 80 per cent this year. Government research suggests 77 per cent of people have no problem with vaccines. Above this, it gets harder.
Frewen said 80 per cent demands a “concerted effort”. Doherty modelling had 70 and 80 per cent reached at November 1 and 22. With lockdowns operating as incentives, an 80 per cent target should be feasible this year – a bonus from current hardship. One problem is lagging states, notably Western Australia.
What happens at 70 and 80 per cent coverage?
The virus is not beaten. But at this point the main trade-off kicks in: because the rates of severe infection are reduced, stringent measures and lockdowns can be reduced. At 80 per cent, the plan is that lockdowns would not be needed for entire states and extended areas, though localised, targeted lockdowns could still be needed.
But the Doherty modelling reveals the ongoing importance of the “test, trace, isolate and quarantine” (TTIQ) capability. This stays as a permanent feature of our health system, public policy and social life. It is vital for public protection. Vaccination alone cannot solve the problem. Thinking that it can will lead to failure. Vaccination is necessary but not sufficient.
“There is no one fix to this virus,” McVernon said. “We are relying on the synergies of intervention to support each other. We have to keep going with the public health TTIQ response and vaccination will markedly assist that.” Vaccination is “a very big part of the answer but it is not the whole answer”.
How significant is the difference between 50-60 per cent vaccination and 70-80 per cent?
This difference looms large in the modelling. It suggests that opening up at the 50-60 per cent range would be dangerous folly. This is a stark warning to politicians, notably to NSW Premier Gladys Berejiklian who earlier in the week was talking about some easing of restrictions at August 29 when, she hopes, NSW reaches 50 per cent coverage (yet that is just one dose).
“At 50 and 60 per cent we anticipate rapidly growing outbreaks that would be very difficult to control and would require stringent social measures,” McVernon said. By that she means Victoria’s phase four lockdown from 2020. Can you imagine the devastating impact if half the population was vaccinated but a massive lockdown was still required?
Two conclusions flow from this. Vaccination cannot be Sydney’s solution before November, hence the need for its lockdown to work. And the entire country faces the prospect of “on and off” lockdowns for the next three to four months.
Even assessing the 70 per cent vaccination scenario, McVernon said the public health (TTIQ) response would be vital to ensure what might “otherwise be a bushfire” was kept to a “controlled backburn”. The Doherty modelling opening-up scenario had infections running four times as great at 50 per cent compared with 80 per cent and deaths running about seven times as great.
What does the modelling say about the demands from conservatives and libertarians for the current lockdowns to be abandoned or seriously eased at this point?
It suggests the risks would be enormous, bordering on the reckless. Obviously, no premier would contemplate such action for the obvious reason – the vaccination coverage is not high enough. Any such action would run counter to all the official health advice.
How great is the change in public mindset required to move from the lockdown to vaccination phase?
It is significant and won’t be easy. Morrison’s language now is that we must “learn to live with the virus”. His hope once phase 3 is reached – the 80 per cent phase – is that the public will perceive this as “not unlike living with an infectious disease like the flu”. This involves a dramatic shift in outlook, but one Australians must make.
Chief Medical Officer Paul Kelly said the transformation involved moving from the current phase – suppression designed to eliminate any community transmission – to a new phase where “we need to accept” hospitalisation, ICU admissions and deaths, accepting them as part of living with the virus and seeking to limit its impact. It means moving away from the goal of eliminating any community transmission.
How can the vaccine rollout be geared to minimise transmission of the virus?
The Doherty modelling is strong on this point. It shows the way people are vaccinated is critical. The peak spreaders of Covid-19 are people in the 20-39 years age range. They bring it home either to their children or their parents. McVernon said the original road map – targeting the older and most vulnerable – was correct. We had been right to focus on risk reduction as the priority.
But from this point, the recommendation is to focus on transmission. “Immunising younger people and reducing transmission is critical to maximising the gains of a whole population program,” McVernon said. The aim is to bring forward vaccination of the 30-39 age group to the start of September and the 16-29 group to early in October. By the time of any shift to stage 3, the vaccination rate for those aged 60 years and older should be 90 per cent.
How can Australia try to “normalise” the battle against the virus going into 2022?
The essential means is by vaccination. This is the road towards a new normal. There is a possible stumbling block – the demon of another more transmissible variant. Yet further vaccination boosters will continue to be rolled out in 2022 and 2023. Morrison uses the context of the flu to seek a path towards normalisation and to prepare the public for the renewed debate about hospitalisation, ICU admissions and death rates.
Average annual deaths from influenza over 2016-19 were 642. Comparisons with flu can work providing the combined impact of all interventions succeeds in limiting community transmission. The “sweet spot” in the Doherty modelling shows that by combining a “transmission-reducing” vaccine rollout with an effective TTIQ public health capability and a high vaccination target, the health outcomes could be improved around 100-fold or more.
They key is to get right the three key policies – the high vaccination coverage, the strong TTIQ health response, and the vaccine rollout. It is interventions working together that matter.
Is the government pledged to giving special exemptions to those Australians who get vaccinated?
Morrison is pledged to this principle but he believes its implementation rests with the premiers, business and various institutions. The PM said the national road map from phase 2 (the 70 per cent trigger) provides for exemptions for vaccinated people. Presumably this will apply before the end of 2021. Such exemptions will only become far more prominent under phase 3 (the 80 per cent trigger).
The justification is clear: the vaccinated are a lower public risk. There is a public interest and ethical basis for exemptions. Majority public support can be assumed. But Morrison’s initial response is that these public health issues lie within the realm of the states.
The federal government has no plan to pass new laws on the subject of exemptions. Morrison said on Friday Australia has no mandatory vaccination policy and businesses and institutions need to make their own judgments.
Obviously, business must ensure it acts on a legal basis in whatever actions it takes.
What incentives might be given to encourage people to be vaccinated?
Decisions on this are still awaiting. Frewen said this week that “demand is still exceeding supply”, while Morrison said late Friday the vaccine rollout has turned the corner there are still supply issues. Morrison and Frewen say the main incentive for vaccination is the practical impact of people doing the right thing, protecting their health and safeguarding their family and friends.
Frewen said down the track a range of options will be assessed, including cash and lotteries. But Morrison drew a line in the sand this week. He savaged Opposition Leader Anthony Albanese’s $300 cash payment for anybody getting vaccinated. Morrison declared this a vote of “no confidence” in the integrity of Australians. He will fight it and seek to hang this idea around Labor’s head.
Does the Doherty report have any relevance for the ongoing debate over the type of vaccine, AstraZeneca versus Pfizer?
Its findings are dramatic and deserve great publicity. Full AZ vaccine coverage is comparable to full Pfizer coverage in reducing death and hospitalisation. In terms of reducing hospitalisation, AZ rates at 86 per cent compared with Pfizer at 87 per cent. On the ICU admission measure they also compare at 86 per cent to 87 per cent. On deaths AZ reduction effectiveness is 90 per cent compared with 92 per cent for Pfizer. “We have two highly effective vaccines,” McVernon said.
What can Australia learn from the current overseas experience?
McVernon said she felt the current northern hemisphere experience validated the argument being put to national cabinet: “When we look at countries that have reopening to this Freedom Day concept, the Netherlands within two weeks was going back to restrictions in bars, nightclubs and restaurants because even at a reasonable high level of coverage – but lower that we are aspiring to – they saw ongoing social measures were needed to rein in the virus.”
The point is Australia rejects totally any idea that freedom is possible by abandoning the testing, tracing, isolating, quarantining and some social restrictions that have defined the past 18 months. The modelling shows these capabilities are essential and Australians need to understand this point.
What happens over the next several months before we reach the 70-80 per cent targets?
The national cabinet has agreed that during this “suppression” phase the response must be “early, stringent, short lockdowns”. This is now the universal view among Australian governments held by the PM, premiers, the Doherty Institute and Treasury.
Morrison has changed his stance on lockdowns because the Delta variant has changed everything. While Morrison backed the initial reluctance of Berejiklian to lock down, he now warns that lockdown is the “primary tool” in Sydney. Morrison will support premiers, such as Victoria’s Dan Andrews, resorting to the short, tough lockdown.
Morrison’s message is that while the suppression phase lasts, it is the premiers who will take the decisions and carry the responsibility for lockdowns – yet nobody will forget it’s all still a function of the delayed vaccine rollout.
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