With no coronavirus vaccine yet, it’s up to us

Experts warn that complacency will undermine all our efforts so far to come to grips with COVID-19.

A sign of the times at Sydney’s Manly Beach this week. Picture: Getty Images

As we hurry to turn the page on 2020, it would be nice to think medical science had the measure of COVID-19, the year’s catastrophic disrupter.

The vaccines are about to ­arrive, right? All sorted.

Sydney’s northern beaches outbreak should have burst the bubble of complacency for the ­majority of Australians who conducted their Christmas shopping maskless and all-too-often careless of public health protocols.

If you live outside Victoria or the red zone in the NSW capital, ask yourself: did you keep a safe distance in the supermarket queue? Was your day on Friday really hug and kiss-free? Did you follow the advice to eat al fresco?

The wakeup call delivered by the Avalon cluster, now numbering 110 cases, its tentacles reaching all the way to Cairns in far north Queensland, was both timely and cautionary. “We’re not out of the woods,” NSW Premier Gladys ­Berejiklian said on Christmas Eve, appealing to people to stay at home and pare back festivities.

The concern that holiday gatherings could turn out to be super-spreading events is entirely justified, underpinning the urgency of the warnings. NSW’s vaunted testing and contact tracing systems have been pushed by a single and as yet unidentified ­infection breach.

Chances are we will never know who patient zero is. It could be anyone who interacted with an infectious international incomer before or while they were in quarantine or, in the case of aircrew, the light-touch home and hotel sequestering that the states are now moving against.

The lesson is that the virus needs only a sliver of opportunity to erupt and potentially drive us back to where Melburnians were in the bleak depths of the level-four lockdown over winter and early spring. Indications are that the northern beaches eruption peaked last weekend.

If not, you can bet calls will ­intensify to fast-track the vaccine rollout, due to commence in March. Anthony Albanese climbed on the bandwagon on Wednesday, arguing that the federal government should start distribution as soon as the regulator, the Therapeutic Goods Administration, has issued an approval.

If, as expected, this comes in January, “it just seems to me incredibly complacent for the government to say, no, we will sit around for another couple of months before it is available,” the Opposition Leader said.

Both Scott Morrison and Health Minister Greg Hunt have said the timetable stands and unlike the US and Britain, which have given emergency authorisation to frontrunning vaccines, Australia would not abridge the process. Despite their insistence that this would buttress public confidence in the vaccine — “we always aim to under-promise and over-deliver,” Hunt said on Thursday — there is an eminently practical reason to hasten slowly: the government doesn’t have supply on hand.

The two candidate vaccines that were to be manufactured in Melbourne by CSL division Seqiris are both unavailable — permanently so in the case of the University of Queensland jab that was abandoned three weeks ago when Phase 1 human trials returned false-positive readings for HIV, an underestimated glitch in the formulation.

The British-developed Oxford-AstraZeneca offering has been delayed by conflicting trial data over dosage, though it could be approved as soon as next week in Britain and has a provisional determination here from the TGA.

Between them, these vaccines accounted for more than 80 million of the doses that Australia had pre-ordered prior to the collapse of the UQ-CSL program.

That leaves the Novavax and Pfizer products, on track but in punishing demand worldwide.

The Prime Minister announced earlier this month the order of an additional 20 million doses of the Oxford-AstraZeneca vaccine to be predominantly produced under licence by CSL, taking the buy to 53.8 million doses, with 11 million more from Novavax to come from the US to lift its contribution to 51 million. Pfizer is under contract to deliver 10 million doses of its mRNA vaccine — enough to immunise five million people — but Inquirer understands that the first shipment is yet to arrive.

Remember, the failure of UQ’s molecular clamp vaccine took 50 million doses off the table. While these weren’t due to come on line until the third quarter of 2021, speeding the rollout, it is clear there will be a shortfall of supply as originally envisaged. Bringing forward distribution, were it possible, would compound the already challenging task to cover the population and potentially create a clamour for early access. In other words, a lose-lose proposition for the country.

But not for those in vulnerable situations such as healthcare workers, the elderly in nursing homes and immunocompromised people of all ages, including cancer patients. Having led the world in containing the virus, is Australia now succumbing to an over­abundance of caution?

“No, I don’t think we need to press the red emergency button right now,” says Jodie McVernon, director of epidemiology at Melbourne’s Peter Doherty Institute for Infection and Immunity, an important player in framing the national COVID-19 response. “We are not in the same universe as countries that have done that.”

She points out that public confidence in the vaccine is as important as its potency. “We could have a 100 per cent effective vaccine that was also 100 per cent safe but if only 20 per cent of the population took it up it wouldn’t do us much good,” McVernon says.

“The fact that we have not had to use the vaccines with the urgency of the US or the UK does mean we can benefit from the ­additional time.”

An international survey this week by the London-based CT Group, headed by former Liberal Party pollster and strategist Lynton Crosby, found that 72 per cent of Australians would agree to be inoculated, against 57 per cent of Americans, reflecting the trust in this country’s public institutions that has sustained us through the pandemic. The Prime Minister and premiers can take a collective bow alongside Albanese, who dialled down the point scoring at critical junctures.

And unlike in the US, where Donald Trump has been unrelenting in his attacks on the outgoing administration’s ranking coronavirus expert, Anthony Fauci, there was not a tissue between the political leadership and the chief health officers, whose advice has been unequivocally heeded.

McVernon’s colleague and fellow professor at the Doherty Institute, immunologist Dale Godfrey, says Australia has turned out to be a Lucky Country with COVID-19 — though not in the ironic sense in which Donald Horne coined the phrase to describe how the nation prospered post-WWII despite itself. “We should be proud of how we handled this epidemic … there are a lot of people hurting and upset about aspects of the response, but the benefit is we did bring it under control,” Godfrey says.

He agrees with McVernon that the policy of localised containment reflected by Berejiklian’s move to seal off the northern beaches while applying a lighter touch to the rest of Greater Sydney suggests another use for the ­vaccine: ring fencing. This means people inside a hot zone and on its periphery would be inoculated, adding another dimension to any hard barrier patrolled by police or defence personnel.

McVernon stresses it’s a case of horses for courses. Postcode lockdowns were always going to be trickier in Melbourne because of demographic and geographic factors unique to the open-plan Victorian capital, she says. South Australia, now officially free of the Parafield cluster that brought Adelaide to a standstill in November with 33 linked cases, did not have the resources of the east coast behemoths to throw at contact tracing, and probably had no choice but to deploy the broad brush (albeit based on false information that allowed the stay-at-home ­orders to be rescinded when it was uncovered).

“I think it’s hard to say, ‘oh well, postcode lockdowns didn’t work in Victoria so they are useless’,” McVernon says. “You have got to look at what’s going on and read the situation.”

Whatever happens on the northern beaches, where new daily cases continue to decline, down from 30 last Sunday to seven as of Christmas Day, she is adamant we won’t snap back to life as usual when the vaccine arrives. Too much is still unknown about the properties of the virus and whether the lead vaccines’ efficacy in combating it will also contain ­infectiousness — that is, cut the chain of transmission from one person to another.

As an expert member of the Australian Health Protection Principal Committee composed of federal and state CHOs reporting to the national cabinet, McVernon is closely tracking reports of the new and evidently more infectious coronavirus strain that is sweeping Britain. Four cases of the mutant type have been detected among newly arrived international travellers in hotel quarantine in Sydney and Melbourne, while another emergent strain in South Africa seems to be more prevalent among young people, the age group least affected by the pandemic to date.

It’s a worry, McVernon admits. But the British mutation, VUI-202012/01, is difficult to sequence, and to her thinking that might mean it was missed until now. While those infected have been found to carry elevated viral loads, that doesn’t equate to increased serious illness. “What all this exactly means is still under study,” she says. “It could all be a bit of a furphy but there’s enough to say we need to monitor it, we need to see if it is more transmissible. But there is not clear evidence to say that at this point.”

McVernon’s Christmas message to Australians is don’t be lulled. Don’t think it’s over. What people do and don’t do through ­social distancing and hygiene remains the best and, in the absence of a vaccine, only line of defence.

“The public are the frontline health responders and we have never seen that more in this pandemic,” she says.