tag:theconversation.com,2011:/nz/topics/covid-19-vaccine-rollout-98270/articlesCOVID-19 vaccine rollout – The Conversation2023-06-13T12:08:17Ztag:theconversation.com,2011:article/2065872023-06-13T12:08:17Z2023-06-13T12:08:17ZWhy it’s impossible for public policy to rely entirely on science<figure><img src="https://images.theconversation.com/files/530755/original/file-20230608-22-ork9t8.JPG?ixlib=rb-1.1.0&rect=0%2C7%2C5011%2C3278&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A person wearing a protective face mask looks at a street mural during the COVID-19 pandemic in Edmonton Alta, in April 2020.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Jason Franson</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-it-s-impossible-for-public-policy-to-rely-entirely-on-science" width="100%" height="400"></iframe>
<p>One of the abiding lessons from the COVID-19 pandemic is how <a href="https://www.cbc.ca/news/politics/auditor-general-pandemic-covid-phac-1.5963895">poorly prepared we were</a> to deal with a crisis of that magnitude. </p>
<p>Naturally, politicians have promised <a href="https://www.cbc.ca/news/politics/pandemic-covid-review-erskine-smith-wherry-analysis-1.6610550">to develop better strategies for the future</a>, but so far these promises have not been fulfilled. </p>
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<a href="https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man with grey hair smiles with one of the arms of his eyeglasses in his mouth." src="https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530462/original/file-20230606-21-djltby.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Preston Manning takes part in a panel discussion during a conference in Ottawa in May 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Sean Kilpatrick</span></span>
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<p>Perhaps surprisingly, one exception has come from the province of Alberta. In January, the United Conservative Party (UCP) government established a blue-ribbon panel of experts, chaired by Reform Party founder Preston Manning, to investigate whether there are <a href="https://edmontonjournal.com/news/politics/preston-manning-to-chair-albertas-covid-19-committee">“lessons to be learned from Canada’s responses to COVID-19 which will better prepare us to handle future public emergencies.”</a></p>
<p>Because the UCP has since been re-elected, and since the Manning committee is expected to release its final report soon, the government is likely to take its findings seriously.</p>
<h2>A deeper look</h2>
<p>Cynics might anticipate that Manning, as a lifelong conservative, will produce a report that does little more than justify the UCP’s actions during the pandemic. But an early leak from the committee suggests that it may be forced to take a deeper look into the way that such policies are constructed. </p>
<p>That leak revealed that when Albertans were asked to suggest how the government should deal with future health crises, they <a href="https://calgaryherald.com/news/politics/reliance-on-expertise-stronger-cmoh-the-most-common-early-replies-to-manning-led-covid-19-review-panel/wcm/d11c3461-f3b5-4c15-aeb1-abb501da98c8">expressed strong support for increased reliance on medical and scientific expertise — and decreased dependence on the opinions of politicians</a>. </p>
<p>These responses challenge the committee to involve itself in a debate that has long engaged political scientists and economists: Can science tell us what the best public policies are? And the committee will probably soon discover that the answer is “no.” </p>
<p>The reason for this can be seen using an area of economics called <a href="https://doi.org/10.4324/9781003223467">public choice theory</a>. It argues that every public policy decision can be divided into two elements — factual and psychological — and it concludes that science has little to tell us about the latter. </p>
<p>With respect to COVID-19, factual elements include information about how the disease is transmitted, the effect it has on those who contract it and the impact of masks and vaccinations on rates of infection.</p>
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Read more:
<a href="https://theconversation.com/lessons-from-covid-19-for-the-next-pandemic-we-need-better-data-on-workplace-transmission-170023">Lessons from COVID-19 for the next pandemic: We need better data on workplace transmission</a>
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<p>Psychological elements include public perception of the harms of infection, the willingness to accept the risk of illness and death and the cost of accepting restrictions on personal freedom.</p>
<p>The importance of this distinction is that while reliable, scientific information is often available about the factual elements of policy, the same cannot be said for the psychological elements. </p>
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<img alt="A man holds a sign that reads No Vax pass in front of a line of police officers on horseback." src="https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530463/original/file-20230606-17-fuod0g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Police officers on horse back keep watch as hundreds of demonstrators gather at city hall in Calgary in March 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh</span></span>
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<h2>How to measure the emotional costs?</h2>
<p>For example, while there is scientific evidence about how diseases are transmitted and the effectiveness of various treatments, no reliable methods exist for measuring the emotional cost of a bout of COVID-19, the value of lives lost to disease or the impact on people when public health policies restrict personal freedoms. </p>
<p>In these cases, scientific expertise may be helpful in identifying what society’s options are but it cannot determine which of those options is necessarily the best for different people in different circumstances.</p>
<p>Early in the pandemic, <a href="https://www.oecd.org/coronavirus/policy-responses/access-to-covid-19-vaccines-global-approaches-in-a-global-crisis-c6a18370/">governments had to decide which groups would be the first to receive scarce vaccines</a>, for example. Seniors over young adults? Health-care workers over police, teachers or supermarket staff? </p>
<p>“Science” had no answers to these questions, which require that value judgments be made. Instead, politicians were forced to make decisions based on social and psychological factors, none of which could be measured factually.</p>
<p>Similarly, science offered little psychological help to parents when they were deciding whether they should have their children vaccinated against COVID-19. All that medical experts could say was that <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/covid-19-get-facts-vaccinating-children.html">there were both costs — though minimal — and benefits to vaccination.</a> After that it was up to parents to weigh the costs versus the benefits.</p>
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<img alt="A baby is seen from the nose down chewing on a cracker." src="https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530466/original/file-20230606-17-jwicy0.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A baby gnaws on a cracker before getting a COVID-19 vaccine in Ottawa in 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
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<h2>Low vaccination rates for kids</h2>
<p>In Alberta, most parents decided that the psychological costs of vaccination outweighed the fact-based benefits as measured by scientists. By April 2023, <a href="https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#vaccinations">only 9.7 per cent of parents of children one to four years old had chosen to have their children receive even one dose of the COVID-19 vaccine, compared with more than 80 per cent among all other age groups</a>.</p>
<p>This suggests the Manning committee is unlikely to recommend that public policy be based solely on scientific evidence. As science has no way to measure psychological costs and benefits, it cannot answer questions like: What level of quarantining will the public accept in return for reduced health risks? How should the lives of senior citizens be weighed against the lives of front-line workers? </p>
<p>The only way the committee can meaningfully contribute to the debate about how public policy should be made is if it tackles head-on the question of how the psychological impacts of policy can be measured.</p><img src="https://counter.theconversation.com/content/206587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Bruce does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The only way an Alberta COVID-19 committee can meaningfully determine how public policy should be made is if it tackles head-on the question of how to measure the psychological impacts of policy.Christopher Bruce, Professor Emeritus, Economics, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1882062022-08-11T16:21:42Z2022-08-11T16:21:42ZEnduring colonialism has made it harder to end the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/478138/original/file-20220808-8055-ox4drg.jpg?ixlib=rb-1.1.0&rect=0%2C640%2C4795%2C2382&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 patients receive oxygen as they lie in their beds in the intensive care unit of a hospital in Machakos, Kenya, in August 2021. </span> <span class="attribution"><span class="source">(AP Photo/Brian Inganga)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/enduring-colonialism-has-made-it-harder-to-end-the-covid-19-pandemic" width="100%" height="400"></iframe>
<p>Rich countries are <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/who-warns-against-vaccine-hoarding-poor-countries-go-without-2021-12-09/">hoarding vaccine doses</a> while poor countries become <a href="https://english.elpais.com/usa/2021-11-29/low-vaccination-rate-in-poor-countries-creates-breeding-ground-for-coronavirus-mutations.html">breeding grounds</a> for new COVID-19 variants. </p>
<p>The World Health Organization’s <a href="https://www.who.int/initiatives/act-accelerator/covax">COVAX</a> — an abbreviation for COVID-19 Vaccines Global Access — warned that “no one is safe, until everyone is safe,” yet colonial attitudes are an obstacle to reining in the global pandemic.</p>
<p>COVID-19 has shown that global equity and inclusion are necessary to manage global crises. A major lesson from this pandemic is the need to decolonize transnational governance so that the world is better able to handle both future and current global crises and issues.</p>
<h2>COVAX’s naïve failure</h2>
<p>COVAX <a href="https://www.washingtonpost.com/world/2022/03/22/covax-problems-coronavirus-vaccines-next-pandemic/">has failed</a>.</p>
<p>It was supposed to provide vaccinations globally and equitably as well as serve as a mechanism through which both rich and poor countries would access vaccines. More than 80 per cent of the population in rich countries <a href="https://ourworldindata.org/covid-vaccinations#what-share-of-the-population-has-completed-the-initial-vaccination-protocol">is fully vaccinated</a>, compared to less than 10 per cent of the population in poor countries.</p>
<p>Credible reports say that poor countries have been affected the most by the global pandemic both in terms of <a href="https://doi.org/10.1038/d41586-022-01767-z">how deadly it has been</a>, <a href="https://www.oxfam.org/en/research/pandemic-greed">as well as economically</a>. </p>
<p>This summer, we’re seeing new pandemic waves <a href="https://www.bloomberg.com/news/articles/2022-07-16/europe-can-t-shake-covid-as-ba-5-variant-fuels-summer-wave-of-cases">in Europe</a> <a href="https://www.reuters.com/world/asia-pacific/fresh-covid-wave-sweeps-asia-nz-warns-pressure-hospitals-2022-07-14/">and Asia</a> driven by new SARS-CoV-2 variants first spotted in <a href="https://www.nature.com/articles/d41586-022-01730-y">South Africa</a>. </p>
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<img alt="A health-care worker in blue protective garb listens to the breathing of a woman wearing a mask and a pink shirt." src="https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3837&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478135/original/file-20220808-8307-ph0zqz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A woman is screened for COVID-19 at a testing centre in Soweto, South Africa, in May 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Denis Farrell)</span></span>
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<p>COVAX is based on lofty ideals of equity and social justice. The initiative has <a href="https://www.healthaffairs.org/do/10.1377/forefront.20220609.695589">been necessary</a> to moderately balance the gap between rich and poor countries that would have fared worse had it not been launched. </p>
<p>But COVAX <a href="https://www.statnews.com/2021/10/08/how-covax-failed-on-its-promise-to-vaccinate-the-world/">has been called naïve</a> for relying upon the good will of rich countries for funding and on their willingness to wait patiently in line for their own populations’ doses.</p>
<p>COVAX’s good intentions have had to co-exist with “might is right” politics. Rich countries made their own deals and bought large amounts of vaccine supplies before they were even available. </p>
<p><a href="https://hbr.org/2020/05/the-danger-of-vaccine-nationalism">Vaccine nationalism</a> turned COVAX into a broker of charity. The colonial mentality believes it’s OK to cut deals with Big Pharma for vaccine doses ahead of populous poor countries, and to charitably donate to them their <a href="https://doi.org/10.1186/s12992-022-00801-z">soon-to-expire leftovers</a>.</p>
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<a href="https://theconversation.com/covid-19-vaccine-inequity-allowed-omicron-to-emerge-173361">COVID-19 vaccine inequity allowed Omicron to emerge</a>
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<h2>Colonial mentality</h2>
<p>Global capitalism as we know it emerged from a colonial world order set up for exploitation of people and lands. European countries kidnapped people from Africa and enslaved them as they dispossessed Indigenous Peoples. This created the extractive economy of today. </p>
<p>Racial classifications and racism have remained an enduring aspect of the modern world. <a href="https://www.connectedsociologies.org/curriculum/mmw/">Colonialism produced the initial and current gap between the rich and the poor world</a>, and racialized the latter. When the <a href="https://www.britannica.com/topic/mercantilism">mercantilist order of the colonial day</a> morphed into capitalism in the 1800s, the colonial mentality that simply assumes European superiority remained.</p>
<p>This has been the basis for the colonial upper hand of the West and the United States in the type of transnational governance that emerged after the Second World War (the United Nations and <a href="https://www.brettonwoodsproject.org/2019/01/art-320747/">Bretton Woods organizations</a>, including the World Trade Organization, the International Monetary Fund and the World Bank). This has also been the basis for the colonial mentality of today. </p>
<p>COVAX was conceived during the rich <a href="https://time.com/6096172/covax-vaccines-what-went-wrong/">World Economic Forum in Davos in January 2020</a>. As news of the virus emerged from China, two professional white men <a href="https://qz.com/2071543/why-the-covax-vaccine-program-failed/">sipped whisky and envisioned COVAX in a Swiss ski resort bar.</a></p>
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<span class="caption">Seth Berkley, CEO of the vaccine alliance Gavi, gestures as he speaks during a media interview in Switzerland in December 2021.</span>
<span class="attribution"><span class="source">(Salvatore Di Nolfi, Keystone via AP)</span></span>
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<p>Seth Berkley (CEO of the <a href="https://www.gavi.org/">Global Alliance for Vaccines and Immunization, or Gavi</a>) and Richard Hatchett (CEO of <a href="https://cepi.net/">the Coalition for Epidemic Preparedness Innovations, or CEPI</a>), heads of global vaccination networks, discussed pandemic scenarios. They knew the world would need a funding and distribution strategy for shots, so they started thinking about a global solution.</p>
<p><a href="https://cepi.net/wp-content/uploads/2021/09/Proposal-to-establish-a-globally-fair-allocation-system_March-25_2020.pdf">Hatchett wrote a white paper in March 2020</a> and those ideas were the basis for the creation of COVAX in April that year. All this sounds great, but colonial mentality ultimately prevented the success of their initiative. It stopped COVAX from emerging as the co-ordinator of sorely needed 21st-century solidarity. </p>
<h2>Decolonizing crisis governance</h2>
<p>People rarely hear the names of Berkley and Hatchett in the global public sphere. Berkley’s Gavi is a global vaccine alliance that brings together the <a href="https://www.gavi.org/our-alliance">public and private sectors</a>. Hatchett’s CEPI describes itself as a “<a href="https://cepi.net/about/whoweare/">global partnership</a> between public, private, philanthropic, and civil society organizations.” </p>
<p>Today, these two global organizations — supported by the World Health Organization — are dealing with the enduring pandemic. But their <a href="https://doi.org/10.1080/17441692.2021.1987502">transparency and accountability</a> have been questionable.</p>
<p>Gavi designed COVAX without oversight and “with a small group of like-minded advisors, primarily Global North philanthropists, academics, and consultants,” according to a <a href="https://www.doctorswithoutborders.org/latest/covax-broken-promise-vaccine-equity">Doctors Without Borders report</a>. The perspectives of low- and middle-income countries, civil society organizations or regional disease control groups weren’t considered in a meaningful way. </p>
<p>At the same time, <a href="https://doi.org/10.1016/S0140-6736(21)01378-7">pharmaceutical industry</a> representatives have had a seat at the table of major decision-making discussions, and this has helped maintain the status quo of their <a href="https://doi.org/10.1038/d41586-021-01242-1">intellectual property rights</a>.</p>
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Read more:
<a href="https://theconversation.com/perus-covid-19-vaccine-scandal-shows-the-shady-deals-made-with-pharma-companies-155623">Peru's COVID-19 vaccine scandal shows the shady deals made with pharma companies</a>
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<p>The world needs to move beyond myopic national self-interest. It has become apparent that in order to control the COVID-19 pandemic, equity and inclusion are urgently required. </p>
<p>Scientists anticipate <a href="https://www.idrc.ca/en/perspectives/no-one-safe-until-everyone-safe-global-research-global-crises">there will be new pandemics along with climate change crises</a>. This will hardly be the last global public-health emergency. </p>
<p>Out of self-interest, transnational governance needs to embrace true solidarity. World leaders must use <a href="https://www.dukeupress.edu/Assets/PubMaterials/978-1-4780-0149-2_601.pdf">a decolonialized</a> imagination to face these coming global challenges.</p><img src="https://counter.theconversation.com/content/188206/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monica Sanchez-Flores does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A major lesson from the COVID-19 pandemic is the need to decolonize transnational governance so that the world is better able to handle both future and current global crises.Monica Sanchez-Flores, Associate Professor of Sociology, Thompson Rivers UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1810522022-04-12T04:06:44Z2022-04-12T04:06:44ZDid the Morrison government really prevent 40,000 COVID deaths? A health economist checks claims against facts<figure><img src="https://images.theconversation.com/files/457561/original/file-20220412-37887-7kkv4l.jpg?ixlib=rb-1.1.0&rect=0%2C188%2C2986%2C1306&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20220409001645307335?path=/aap_dev16/device/imagearc/2022/04-09/ae/41/e9/aapimage-7khi5pkyat0eci8t1cms_layout.jpg">AAP Image/Supplied by Office of the Prime Minister</a></span></figcaption></figure><p>As an opening gambit to his re-election campaign, Prime Minister Scott Morrison claimed his handling of the pandemic had <a href="https://www.theguardian.com/australia-news/2022/apr/09/scott-morrison-takes-credit-for-saving-40000-lives-from-covid-in-social-media-pitch-for-re-election">saved 40,000 lives</a>.
This figure compares Australia over 2020 and 2021 with an average derived across higher-risk <a href="https://www.pm.gov.au/media/press-conference-canberra-act-38">predominantly northern hemisphere countries</a>.</p>
<p>He made similar comparisons to much higher-risk countries two years ago, at a <a href="https://www.abc.net.au/news/2020-04-07/scott-morrison-press-conference-coronavirus-crisis-modelling/12129550">press conference</a> on April 7 2020. Morrison and Chief Medical Officer Brendan Murphy pointed to COVID graphs comparing Australian cases with modelling.</p>
<p>“We have so far avoided the many thousands, if not tens of thousands, of cases that may have otherwise occurred by this point across the Australian community — and indeed the many more fatalities that could also have occurred by this point,” he said then, urging Australians to “hold the course. We must lock in these gains.” </p>
<p>But a comparison with equivalent countries tells a very different story about the claim to have saved <a href="https://www.theguardian.com/australia-news/2022/apr/12/fact-check-did-scott-morrison-really-save-40000-lives-from-covid">40,000 lives</a>. </p>
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Read more:
<a href="https://theconversation.com/heres-why-you-might-need-a-4th-covid-vaccine-dose-this-winter-177811">Here's why you might need a 4th COVID vaccine dose this winter</a>
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<h2>The wrong comparison</h2>
<p>Given Australia’s very different environment as an island in the Oceania region and strong evidence transmission of initial COVID strains were highly seasonal and temperature dependant, the comparison with OECD countries in the northern hemisphere doesn’t hold.</p>
<p>Australian-led <a href="https://www.medrxiv.org/content/10.1101/2020.03.18.20036731v1.full.pdf">research</a> as early as February 2020 showed there were significant reductions in rates of COVID transmission associated with temperature. Higher average temperature was strongly associated with lower cases.</p>
<p>Those findings were confirmed by global research <a href="https://openres.ersjournals.com/content/6/4/00550-2020">comparing</a> 117 countries with more than 100 cases up to April 10 2020. That showed there was an average 5.4% reduction in case transmission for each degree increase in temperature above 0 centigrade and explained 72% of variation. </p>
<p>During 2020 this <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.9.2000202">was reflected</a> in rapidly increasing cases during European and North American winters. Numbers then tailed off in summer as temperatures rose while the South American winter saw case rates increase.</p>
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<a href="https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457556/original/file-20220412-36930-jglebd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Family members remember loved ones lost to COVID on the National Covid Memorial wall in London.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20220330001641337583?path=/aap_dev3/device/imagearc/2022/03-30/d8/44/be/aapimage-7kc3ievebyt1iyfbqiry_layout.jpg">AP Photo/Alastair Grant</a></span>
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<h2>Comparing within our region</h2>
<p>As an island in the Oceania region, Australia’s 2020 outbreaks were largely restricted to those imported by air and sea travel, flourishing in the colder environments of <a href="https://www.abc.net.au/news/2020-07-26/coronavirus-covid-19-meatworks-abattoirs-victoria/12490178">meatworks</a>, until temperatures dropped with winter and outbreaks started to emerge in Tasmanian hospitals and in Melbourne – the coldest, high-density urban population centre in Australia.</p>
<p>A robust comparison for Australia over 2020 is with Oceania region countries that faced the same environmental risks with original variants. At December 21 2020, Australia had the highest COVID case rates (1,101 per million) and death rate (35 per million) of <a href="https://www.worldometers.info/coronavirus/#countries">all Oceania countries </a>, other than French Polynesia which opened up to cruise ships in August 2020. </p>
<p>However, Oceania’s climatic cloak of protection in 2020 would not last.</p>
<h2>New variants brought greater risks</h2>
<p>The Delta variant was much <a href="https://asm.org/Articles/2021/July/How-Dangerous-is-the-Delta-Variant-B-1-617-2">more transmissible</a> than the original COVID strains and able to transmit at <a href="https://www.researchgate.net/publication/357276555_Challenges_in_the_control_of_COVID-19_outbreaks_caused_by_the_delta_variant_during_periods_of_low_humidity_an_observational_study_in_Sydney_Australia">higher temperatures</a>. This was clear from the catastrophic spread that occurred at the <a href="https://qz.com/india/2024190/how-dangerous-are-covid-19-delta-and-delta-plus-variants/">height of the Indian summer</a> in April and May of 2021.</p>
<p>When the Delta outbreak emerged in Sydney in June 2021 from an unvaccinated limousine driver, less than 4% of the <a href="https://ourworldindata.org/grapher/people-fully-vaccinated-covid?country=%7EAUS">Australian population</a> was double-dose vaccinated. The percentage in NSW was lower still, an at-risk population <a href="https://www.smh.com.au/national/we-re-sitting-ducks-the-case-for-a-short-sharp-lockdown-to-battle-delta-variant-20210624-p5840i.html">of sitting ducks</a>.</p>
<p>Yet right up until June 26 2021 Morrison <a href="https://www.sbs.com.au/news/article/scott-morrison-confident-sydney-can-avoid-lockdown/uyv26vgqq">claimed</a> no lockdown was required to address the Delta outbreak, despite the absence of broad vaccine protection. </p>
<p>The low vaccination rate was attributable to reliance on one vaccine and the <a href="https://www.theguardian.com/society/2021/apr/11/australias-covid-vaccination-relying-on-opaque-private-contracts-worth-millions">contracting out</a> of many aspects of the rollout to a range of for-profit companies. Each aspect of the process proved <a href="https://theconversation.com/were-paying-companies-millions-to-roll-out-covid-vaccines-but-were-not-getting-enough-bang-for-our-buck-164550">poor value</a>, including vaccine rollout strategies and planning, vaccine distribution, delivery of vaccination programs in aged care, and systems meant to monitor these activities.</p>
<h2>Bottom line: the relevant comparison is to New Zealand</h2>
<p>The federal government’s claims of success show it did not learn the importance of the <a href="https://www.bmj.com/content/375/bmj.n3111">precautionary principle</a> – a decision-making approach used in public health and environmental fields that urges caution when the science and risks are still uncertain – and wasted the luck Australia had in 2020.</p>
<p>To say there has been a saving of 40,000 lives relies on a comparison to the northern hemisphere at the beginning of the pandemic when Australia had a climatic cloak of protection and a safe distance from which to learn from overseas evidence.</p>
<p>New Zealand provides a more useful comparison if we’re to judge the success of the Morrison government’s pandemic handling. Our neighbour faced the closest set of climate and wider conditions to us and had similarly high levels of PCR testing (at least until Omicron overwhelmed testing in late 2021). On this comparison, Australia did not do well. </p>
<p>By September 15 2021, <a href="https://www.worldometers.info/coronavirus/#countries">COVID case rates</a> in Australia were almost four-fold that of NZ (3,038 versus 796 cases per million) with more than eight times the death rate (43 versus 5 five per million) – further puncturing the Morrison government’s 40,000 lives boast. </p>
<p>In November 2021, the federal government claimed it was <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/minister-hunts-press-conference-on-27-november-2021-the-omicron-variant-travel-restrictions-and-covid-19-vaccination">well prepared</a> for Omicron, but 70% of all <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">COVID deaths in Australia</a> (4,579 out of 6,569 as of April 11) <a href="https://www.theguardian.com/australia-news/datablog/2022/jan/21/australia-has-had-its-deadliest-day-yet-covid-omicron-heres-what-we-know-about-who-is-dying">occurred after that date</a>. The <a href="https://www.worldometers.info/coronavirus/country/australia/">majority of those were in 2022</a> and are therefore not accounted for in the 2020 and 2021 comparison underlying the 40,000 lives saved claim.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-cases-are-rising-but-we-probably-wont-need-more-restrictions-unless-a-worse-variant-hits-179969">COVID cases are rising but we probably won't need more restrictions unless a worse variant hits</a>
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<img src="https://counter.theconversation.com/content/181052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Eckermann does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s the comparison behind COVID-19 claims Scott Morrison has been making for two years. But comparing with countries at the same environmental risk shows Australia’s pandemic failures throughout.Simon Eckermann, Professor of Health Economics, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1743952022-01-09T17:34:29Z2022-01-09T17:34:29ZShould my child have a COVID vaccine? Here’s what can happen when parents disagree<figure><img src="https://images.theconversation.com/files/439436/original/file-20220105-15-3b1vgy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-unhappy-girl-sitting-armchair-while-1085265074">Shutterstock</a></span></figcaption></figure><p>Australian children aged 5-11 are eligible to receive their COVID-19 vaccine <a href="https://www.ncirs.org.au/safety-side-effects-allergies-and-doses-covid-19-pfizer-vaccine-5-11-year-olds-explained">from today</a>.</p>
<p>For many parents, vaccinating their child is a shared decision with both parents agreeing to go ahead.</p>
<p>But not all parents agree.</p>
<p>As we roll out COVID vaccines to younger children this week, what options are there if one parent wants to vaccinate their child but the other doesn’t?</p>
<h2>Why do parents disagree about COVID vaccines?</h2>
<p>Before COVID, parents chose to vaccinate their children for a <a href="https://www.racgp.org.au/afp/2017/march/parental-attitudes-beliefs-behaviours-and-conc-2">range of reasons</a>. This included a feeling of social responsibility, a belief in the protective medical benefit and safety of vaccines, and possibly a financial incentive, driven by policies including “<a href="https://www.ncirs.org.au/public/no-jab-no-play-no-jab-no-pay">No Jab No Pay</a>”.</p>
<p>However, for some, barriers to timely vaccination <a href="https://gh.bmj.com/content/6/9/e006860.long">remain</a>. For instance, childhood illnesses may have prevented vaccination, or it may be difficult to get to a vaccine clinic because of work commitments or lack of transport.</p>
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<strong>
Read more:
<a href="https://theconversation.com/why-do-people-not-vaccinate-24882">Why do people not vaccinate?</a>
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<p>Others believe vaccination has unacceptable side effects or immunisation is ineffective in preventing disease. Others believe vaccines contain harmful substances, prefer natural or homeopathic alternatives, or mistrust medical evidence supporting the safety and efficacy of vaccination.</p>
<p>A minority of parents also falsely believe these <a href="https://www.jpeds.com/article/S0022-3476(21)00688-0/fulltext">apply</a> to COVID-19 vaccines.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1478490177303687169"}"></div></p>
<h2>Why are disputes more of an issue now?</h2>
<p>As we roll out COVID-19 vaccines to more children, vaccine disputes between parents may rise.</p>
<p>If parents disagree, what happens next partly depends on the <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0019/1107082/covid-vaccine-consent-young-people.pdf">age and maturity of the child</a>.</p>
<p>For instance, teenagers aged 16 years and older are usually considered to have the capacity to <a href="https://www.healthdirect.gov.au/covid-19-vaccination/getting-the-covid-19-vaccination#how-to-consent">consent</a> for themselves. So if parents disagree, older teenagers with the capacity to consent can go ahead and get their shot anyway.</p>
<p>Where disputes are likely to arise is for younger children. For those aged 12-15, vaccinators like to see agreement from the adolescent to be vaccinated plus consent from the parent or guardian.</p>
<p>For children under 12, a <a href="https://www.health.gov.au/sites/default/files/documents/2021/12/covid-19-vaccine-information-and-consent-form-for-parents-and-guardians-of-children-aged-5-to-11-years.pdf">parent or guardian</a> needs to provide consent as young children are not deemed to have capacity to do so. </p>
<p>Written consent to vaccination is not required in Australia.</p>
<h2>What happens next?</h2>
<p>When parents disagree over whether to vaccinate their child, the child may be delayed in getting vaccinated or can remain unvaccinated until they can consent themselves.</p>
<p>Depending on the relationship between parents and whether it is safe to do so, parents can look together at <a href="https://mvec.mcri.edu.au/references/covid-19-vaccination-in-children/">reliable sources of information</a> and answers to <a href="https://ncirs.org.au/covid-19/covid-19-and-children-frequently-asked-questions">frequently asked questions</a> about vaccination. These may address any misunderstandings or disagreements.</p>
<p>Seeking external advice from a neutral third party, such as a GP or <a href="https://ncirs.org.au/health-professionals/specialist-immunisation-services">specialist immunisation service</a>, is also recommended. Other options include getting in touch with community organisations, such as <a href="https://www.abc.net.au/news/2021-12-18/covid-relationships-breakdown-counsellors/100707476">family relationships organisations</a>, or the <a href="https://www.familyrelationships.gov.au/talk-someone/advice-line">Family Relationship Advice Line</a> (1800 050 321). These may be able to advise about mediation.</p>
<p>If these methods fail, going to court may be the last resort. This comes with significant financial and emotional costs, so is best avoided.</p>
<p>Australia’s Family Court has set up a <a href="https://www.fcfcoa.gov.au/fl/pd/fam-covid">COVID-19 list</a> to prepare for hearing disputes about children being vaccinated against COVID-19. The courts have already seen a <a href="https://www.smh.com.au/national/rise-in-vaccination-disputes-hitting-the-family-court-20211223-p59jqx.html">rise in applications</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1475916623131250690"}"></div></p>
<p>We can’t say for certain how the courts will decide. What we do know, however, is what happened when non COVID-19 vaccination disputes went to court.</p>
<h2>The court has favoured vaccination</h2>
<p>In research we have submitted for publication, we reviewed 27 cases involving parental disputes involving non COVID-19 immunisations. These went to court in Australia between 2002 and 2021. </p>
<p>In 21 of those cases, the court decided in favour of the parent who supported vaccination. In five cases, the court declined to make a decision due to a lack of medical expert evidence presented and asked this be gathered for future hearings. In only one case was parental responsibility awarded to the party opposing vaccination. </p>
<p>In all cases where traditional Western medical expert evidence was presented, the court decided in favour of the parent who supported vaccination.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/safety-side-effects-allergies-and-doses-the-covid-19-pfizer-vaccine-for-5-11-year-olds-explained-173323">Safety, side effects, allergies and doses. The COVID-19 Pfizer vaccine for 5-11 year olds explained</a>
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<p>In many cases, courts made statements on the individual and public benefits of immunisation. Common themes across judgements included: </p>
<ul>
<li>any potential risks of vaccination are greatly outweighed by the risk of harm from vaccine-preventable diseases</li>
<li>failure of a parent to immunise exposes a child to risk of harm</li>
<li>indirect benefits of immunisation to the community argues in favour of vaccination.</li>
</ul>
<p>Many of these statements made about non COVID-19 vaccines also apply to COVID-19 vaccines.</p>
<p>Based on prior experience it seems likely courts will decide in favour of immunisation.</p>
<h2>Start the discussion now</h2>
<p>Almost 80% of Australian 12 to 15 year olds have had one dose of COVID vaccine and about 73% have had two doses. So if <a href="https://www.health.gov.au/sites/default/files/documents/2022/01/covid-19-vaccine-rollout-update-5-january-2022.pdf">vaccine uptake</a> in this age group is an accurate guide of parents’ views, we are likely to see similar high uptake in children aged 5-11. </p>
<p>Over <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic">7 million children</a> aged 5-11 in the US have received the first dose of COVID-19 vaccine and over 4 million have had two doses. </p>
<p>Clinical trial data of children this age <a href="https://theconversation.com/safety-side-effects-allergies-and-doses-the-covid-19-pfizer-vaccine-for-5-11-year-olds-explained-173323">showed</a> they made antibodies and the vaccine showed efficacy. Real-world data is anticipated. There have been <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-01-05/03-COVID-Hause-508.pdf">no safety concerns to date</a>.</p>
<p>So, if you haven’t already started talking about vaccinating your child, now is the time.</p>
<p><em>Grace Barbara, a 4th year medical student at the University of Sydney, conducted the review of legal cases and contributed to research mentioned in this article.</em></p><img src="https://counter.theconversation.com/content/174395/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a Career Development Fellowship. He holds a Churchill Fellowship awarded in 2019.</span></em></p>Not all parents agree about vaccinating their child. Here’s what’s likely to happen if cases go to court.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1708612021-11-08T14:41:18Z2021-11-08T14:41:18ZNose sprays, needle-free patches, durable immunity: towards the next generation of COVID vaccines<figure><img src="https://images.theconversation.com/files/430692/original/file-20211108-58905-1ws7bs8.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C7044%2C4675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20200720001480978146?path=/aap_dev4/device/imagearc/2020/07-20/0b/85/7c/aapimage-7bj0eplpfmg8rs2j1uk4_layout.jpg">John Cairns, University of Oxford via AP</a></span></figcaption></figure><p>The past 20 months has seen an explosion of vaccine development, with COVID vaccine testing and rollout happening at an unprecedented pace in the face of a global pandemic. There have been absolute triumphs – the fact we have multiple safe, effective vaccines is remarkable – but there have also been challenges. </p>
<p>We’ve seen storage and delivery issues, vaccine hesitancy, breakthrough infections and the beginnings of waning immunity.</p>
<p>Vaccine innovators around the world have these challenges in their sights. They are already working on the next generation of COVID vaccines.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-vaccines-for-5-to-11-year-olds-are-inching-closer-heres-what-we-know-so-far-169732">COVID vaccines for 5 to 11 year olds are inching closer. Here's what we know so far</a>
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<h2>Tweaking current vaccines</h2>
<p>After hundreds of millions of doses, we have a good handle on how current vaccines are performing and where they can be improved. As more data is gathered, a modified dose, time between doses, and/or using different vaccines together in mix-and-match strategies may become the preferred approach.</p>
<p>We could also improve vaccines that aren’t performing at their best. </p>
<p>Inactivated vaccines have been used in many parts of the world but their early protection has waned, <a href="https://www.nature.com/articles/d41586-021-02796-w">particularly in older people</a>, with the World Health Organisation now <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE_recommendation-Sinovac-CoronaVac-2021.1">recommending a third dose</a>. </p>
<p>One way to improve this could be to add an adjuvant – something that fires up the immune system. One such vaccine, called Valneva, has early results that suggest including an adjuvant <a href="https://valneva.com/press-release/valneva-reports-positive-phase-3-results-for-inactivated-adjuvanted-covid-19-vaccine-candidate-vla2001/">improves immunity</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vial of vaccine in gloved hand" src="https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430681/original/file-20211108-9947-w7x8sz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">New vaccines and new modes of delivery are on the way.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1623682687393-9676a1ddec3c?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1yZWxhdGVkfDF8fHxlbnwwfHx8fA%3D%3D&auto=format&fit=crop&w=600&q=60">Unsplash/mika baumeister</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Making vaccination easier</h2>
<p>As we have seen, vaccinating large numbers of people is not easy. Innovations to make this easier will be welcome.</p>
<p>Needle-free approaches would be ideal. One approach, known as a nanopatch vaccine, coats the vaccine onto tiny spikes on a small patch. </p>
<p>The patch is applied to the skin and the spikes deliver the vaccine to a dense barrier of immune cells sitting just under the top layers of our skin. A nanopatch COVID vaccine developed by Vaxxas and researchers in Queensland has been shown to trigger <a href="https://www.science.org/doi/10.1126/sciadv.abj8065">strong immune responses in animal models</a>, with trials underway in humans.</p>
<p>Another approach, known as an intranasal vaccine, sprays a vaccine up the nose. This would be easier to deliver and it could also build immunity in the right location in our body. </p>
<p>The coronavirus infects us through the lining of the nose, mouth, throat and lungs – a type of sticky tissue that lines body cavities and some organs called <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/mucosa">mucosa</a>. </p>
<p>Currently, COVID vaccines are delivered into our arm muscle and build antibody levels in our blood and tissue, with <a href="https://onlinelibrary.wiley.com/doi/10.1002/cti2.1354">some antibody spilling out into the mucosa</a>. Delivering the vaccine <a href="https://www.science.org/doi/10.1126/scitranslmed.abh0755">directly to the mucosa</a> might be a better approach for preventing COVID infection. This is being trialled with a number of vaccines, including the <a href="https://clinicaltrials.gov/ct2/show/NCT04816019?term=intranasal+vaccine&cond=covid-19&cntry=GB&draw=2&rank=2">AstraZeneca vaccine</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1456552878743638019"}"></div></p>
<p>If yearly COVID boosters are recommended for some or even all of the population, it would be easier to deliver them together with the yearly flu vaccine. These “multipathogen” vaccines are being tested with current flu vaccine or <a href="https://ir.novavax.com/2021-09-08-Novavax-Initiates-Phase-1-2-Clinical-Trial-of-Combination-Vaccine-for-COVID-19-and-Seasonal-Influenza">even new types of flu vaccine</a>.</p>
<h2>More durable immunity</h2>
<p>With two doses of the current vaccines, <a href="https://www.nature.com/articles/s41591-021-01548-7">immunity is seen to decline</a> and poor responses are seen in certain groups such as the severely immune-compromised and older people. COVID vaccines that can induce more durable immunity, more consistently across vulnerable populations would be a major innovation. </p>
<p>This could require completely new vaccines. Protein subunit vaccines – which use purified protein from the surface of the virus as a target – are still working their way through approvals around the world. </p>
<p>One example is the <a href="https://www.tga.gov.au/tga-grants-additional-provisional-determination-covid-19-vaccine">Novavax vaccine</a>, but there are a <a href="https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines">large number of other protein subunit vaccines also development</a> that often use new adjuvants – again, the vaccine ingredient that fires up your immune system. These new adjuvants could support more durable immunity but this remains to be tested.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman gets injection" src="https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430686/original/file-20211108-10695-joyh3i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaccine protection is more likely to wane in immunocompromised and older people.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-doctor-preparing-vaccine-older-600w-1928974274.jpg">Shutterstock</a></span>
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</figure>
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Read more:
<a href="https://theconversation.com/australians-will-soon-receive-covid-booster-vaccines-why-do-we-need-them-and-how-effective-are-they-170368">Australians will soon receive COVID booster vaccines. Why do we need them, and how effective are they?</a>
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<h2>Protection against future variants</h2>
<p>We can also update the current vaccines by changing their target. All current COVID vaccines use a target from the original strain of the coronavirus to train the immune system. </p>
<p><a href="https://www.nature.com/articles/s41591-021-01548-7">This is okay for vaccinating</a> against the Delta strain, as this new virus still looks pretty similar to the original virus to your immune system. But new viruses could emerge that the immune system struggles to recognise. </p>
<p>We could simply use a new target from a new virus. Some vaccines have been updated to target the <a href="https://www.sciencedirect.com/science/article/pii/S0092867421002269?via%3Dihub">Beta strain</a>, which is relatively hard for our immune system to recognise. <a href="https://www.nature.com/articles/d41586-021-02854-3">Trials are being run</a> with these Beta-targeted vaccines as a dry run, to make sure that we can update vaccines if we need to. </p>
<p>A more ambitious approach would be to focus the immune response on a target/s common to all coronaviruses. This “pan-coronavirus” vaccine would hopefully provide protection from all or most coronaviruses. Again, <a href="https://www.biorxiv.org/content/10.1101/2021.03.24.436523v1">early data from animal models</a> are promising.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1454665419785129985"}"></div></p>
<h2>Working out if vaccines are working</h2>
<p>An important innovation for COVID vaccines would be an immune correlate.</p>
<p>An immune correlate is something that can be measured in an immune response to indicate if someone will be protected against infection or not. For <a href="https://immunisationhandbook.health.gov.au/recommendations/serological-testing-for-immunity-to-rubella-is-only-recommended-before-or-after">rubella</a> and <a href="https://immunisationhandbook.health.gov.au/recommendations/non-responders-to-hepatitis-b-vaccine-are-recommended-to-receive-further-doses-and">hepatitis B virus</a>, we measure the amount of antibody targeting these viruses in our blood. If antibody is absent or too low, a booster dose of the vaccine is recommended. </p>
<p>An immune correlate for COVID could similarly allow us to identify people that need a booster.</p>
<p>Some researchers, including <a href="https://www.nature.com/articles/s41591-021-01377-8">Australian teams</a>, are sorting through data from around the world to see if there is something we can measure in our immune response to use as a correlate for COVID.</p>
<p>Research around the world is driving us towards the next generation of COVID vaccines. Innovations for COVID vaccines will lead to better vaccines for other infections too – those that currently afflict humanity and those that are yet to emerge.</p><img src="https://counter.theconversation.com/content/170861/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Quinn receives funding from the Rebecca L. Cooper Foundation, CASS Foundation and the Medical Research Future Fund.</span></em></p>The development of COVID vaccines has already been explosive. There are more innovations on the way.Kylie Quinn, Vice-Chancellor's Research Fellow, School of Health and Biomedical Sciences, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686212021-09-28T14:37:43Z2021-09-28T14:37:43ZWant to know about vaccine rollouts in Africa? Click on a country here and find out<figure><img src="https://images.theconversation.com/files/423285/original/file-20210927-15-p13kio.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><iframe frameborder="0" width="100%" height="1100" src="https://hosted.mediahack.co.za/tca-vaccination-tracker/"></iframe>
<p>There has been a lot of focus on COVID-19 vaccine inequalities between high-income and low- and middle-income countries. For instance, it is estimated that up to <a href="https://www.openaccessgovernment.org/covid-vaccines-in-2021/103800/">70%</a> of all vaccines to be produced in 2021 were pre-booked by a handful of countries.</p>
<p>This has caused severe bottlenecks in vaccine supply to low- and middle-income countries, leading to huge differences in vaccination rates. On <a href="https://ourworldindata.org/covid-vaccinations">average</a>, out of 100 people in a high-income country, 61 have received at least one dose of the COVID-19 vaccine. In the 29 low-income countries, only 3 out of 100 people have received one dose of the <a href="https://ourworldindata.org/covid-vaccinations">vaccine</a>. In the whole of Africa, about 10 out of 100 have received at least one dose and only 4 out of 100 are fully <a href="https://ourworldindata.org/covid-vaccinations">vaccinated</a>. </p>
<p>Such inequity means that while economies of high-income countries recover and life returns to normal, low-income countries will continue to struggle with slower economic recovery and the knock on effects.</p>
<p>As time goes on, another picture is emerging. That is one of the inequities among African countries. While on <a href="https://ourworldindata.org/covid-vaccinations">average</a> 4 in 100 Africans are fully vaccinated, there are more than 30 countries where less than 5 in 100 people have received a <a href="https://app.powerbi.com/view?r=eyJrIjoiY2ViYzIyZjItYzhkMi00ZWVkLTgyM2ItZTk1ZTJmODRjMTkxIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9">single dose</a>. The top five vaccinated countries in Africa include three island states and two countries in North Africa with full vaccination rates ranging from <a href="https://app.powerbi.com/view?r=eyJrIjoiY2ViYzIyZjItYzhkMi00ZWVkLTgyM2ItZTk1ZTJmODRjMTkxIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9">20% to 72%</a>. </p>
<p>Almost half of the countries in Africa have full vaccination rates <a href="https://app.powerbi.com/view?r=eyJrIjoiY2ViYzIyZjItYzhkMi00ZWVkLTgyM2ItZTk1ZTJmODRjMTkxIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9">below 2%</a>. </p>
<p>To help us keep track of vaccine roll-out across the continent, The Conversation Africa teamed up with Africa Data Hub to provide a map with regularly updated data illustrating vaccine distribution. </p>
<p>At a time when the vaccine supply to Africa has increased, partly due to donations from high-income countries and partly due to access to more vaccine options such as Sinopharm and J&J, it is important to understand how that translates to vaccines into people’s arms. And to be able to track whether existing inequalities among African countries persists. </p>
<p>In the medium term, the map will be invaluable in tracking how an increase in the COVID-19 vaccine uptake affects the countries’ ability to withstand new waves of infection. The goal of the world should be to have all countries achieving high rates of vaccination necessary to protect their whole population from further outbreaks. Such tracking tools help us to see how much progress we are making.</p><img src="https://counter.theconversation.com/content/168621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Kyobutungi receives funding from The African Academy of Sciences, Sida, The Hewlett Foundation and The Bill and Melinda Gates Foundation</span></em></p>Almost half of the countries in Africa have vaccination rates below 2%.Catherine Kyobutungi, Executive Director, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1683412021-09-28T10:47:31Z2021-09-28T10:47:31ZWhat the world can learn from Bhutan’s rapid COVID vaccine rollout<figure><img src="https://images.theconversation.com/files/423549/original/file-20210928-28-7duqjo.jpg?ixlib=rb-1.1.0&rect=269%2C84%2C4827%2C3200&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/buddha-dordenma-statue-big-golden-thimphu-1459271045">NiarKrad/Shutterstock</a></span></figcaption></figure><p>Nearly half the world’s population <a href="https://ourworldindata.org/covid-vaccinations">has received at least one dose</a> of a COVID-19 vaccine. But figures vary widely between countries. Many low and middle-income countries have barely started their vaccination campaigns.</p>
<p>But the tiny Himalayan nation of Bhutan isn’t one of them. By the end of July, it had fully vaccinated 90% of its adults. Despite having few doctors and nurses, across <a href="https://www.unicef.org.au/blog/stories/covid-vaccine-delivery">just three weeks</a> in the summer it delivered a second vaccine dose to nearly every adult in the country. This is a remarkable <a href="https://www.theguardian.com/world/2021/jul/27/bhutans-rapid-covid-vaccine-rollout-hailed-as-international-success-story">success story</a> for one of the <a href="https://unctad.org/topic/least-developed-countries/list">least developed countries</a> in the world. </p>
<p><a href="https://thediplomat.com/2021/06/bhutans-health-minister-on-navigating-the-pandemic-as-a-small-state/">Health minister Dechen Wangmo</a> credits solidarity, Bhutan’s small size and its science-based policymaking for its success. Its achievement highlights how logistical challenges and vaccine hesitancy can be overcome.</p>
<h2>Donations are crucial</h2>
<p>Bhutan’s success wouldn’t have been possible without international cooperation. Its first vaccines were <a href="https://www.hindustantimes.com/india-news/bhutan-maldives-first-to-benefit-from-india-s-vaccine-maitri-101611191910201.html">donated by India</a>. By March 2021, India had sent 450,000 doses of the AstraZeneca vaccine, enough to give all eligible adults in Bhutan their first dose in the spring.</p>
<p>But getting hold of second doses was a challenge. India’s second wave soon arrived, causing it to prioritise domestic immunisations and <a href="https://www.thehindu.com/news/international/hit-by-indias-vaccine-export-ban-bhutan-seeks-help/article35006213.ece">ban vaccine exports</a>. Bhutan’s immediate source of doses had dried up, while India’s mounting caseload over the border posed a rapidly increasing infection risk.</p>
<p>After a tense wait, <a href="https://www.unicef.org/bhutan/press-releases/bhutan-receives-500000-doses-covid-19-vaccines-through-covax">500,000 doses</a> of the Moderna vaccine came from the US through <a href="https://www.gavi.org/vaccineswork/covax-explained">Covax</a>, the vaccine-sharing initiative. An additional <a href="https://www.southasiamonitor.org/bhutan/bhutan-receive-250000-astrazeneca-vaccines-denmark">250,000</a> doses of the AstraZeneca vaccine came from Denmark, followed by supplies of AstraZeneca, Pfizer and Sinopharm vaccines from Bulgaria, Croatia, China and other countries.</p>
<h2>Planning makes the logistics work</h2>
<p>Distribution was another big part of the puzzle. Bhutan is remote. Land access is only possible on a few roads from India. The Covax vaccines arrived by air at Paro International Airport. One of the most <a href="https://simpleflying.com/bhutan-paro-airport-exclusivity/">challenging landings</a> in the world, Paro sits in a deep valley. The surrounding peaks are as high as 5,500 metres. </p>
<p>Domestic transport is also challenging. Bhutan’s population of almost 750,000 is scattered over an area roughly the size of Switzerland. Not all of the mountainous country is accessible by road. </p>
<p>Because of this, the health ministry had to plan in detail how to get all adults their first and second doses as quickly as possible. This involved extensive field visits to remote districts, to map where people were and identify possible vaccination sites. The visits also <a href="https://news.un.org/en/story/2021/05/1092422">established ways of supplying</a> these sites – by road, air or even on foot for the most inaccessible areas. </p>
<p>Schools, monasteries and other public buildings <a href="https://www.gov.bt/covid19/vaccination-distribution-plan-moh/">were used</a> as vaccination centres. Keeping vaccines sufficiently cold at smaller locations could be challenging, so district hubs were created across the country to store vaccines and coordinate distribution to smaller sites as doses were needed. Domestic flights and a helicopter shuttle service were used to move doses around the country.</p>
<p>And a digital platform – the <a href="https://www.asia-pacific.undp.org/content/rbap/en/home/presscenter/pressreleases/2021/a-new-digital-system-drives-bhutan-s-covid-19-vaccination-succes.html">Bhutan Vaccination System</a> – helped speed up the rollout of second doses. It allowed people to pre-register online before receiving their jab and so not waste time filling in personal details at the vaccine centre.</p>
<figure class="align-center ">
<img alt="Vaccine doses supplied by the US arriving at Paro International Airport, Bhutan" src="https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=322&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=322&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=322&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423547/original/file-20210928-14-1cn912w.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Covax vaccine supplies arriving at Paro airport.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:The_United_States_Delivers_COVID-19_Vaccine_Doses_to_Bhutan_(51307679170).png">US Department of State</a></span>
</figcaption>
</figure>
<p>User research was also central to Bhutan’s <a href="https://gh.bmj.com/content/6/5/e005977">planning phase</a>. The health ministry ran online conferences with healthcare workers and authorities at district and village level to highlight expected challenges. Simultaneously, the ministry mobilised and trained healthcare workers to vaccinate and monitor patients.</p>
<p>But with only 376 doctors in the country, the planning phase soon identified a shortage of medical personnel. So 50 registered doctors known to be studying overseas were <a href="http://www.populationmedicine.eu/Recalling-doctors-back-to-Bhutan-for-COVID-19,125913,0,2.html">recalled</a>. </p>
<p>Nurses and healthcare workers were supported by the “<a href="https://desuung.org.bt/">Guardians of the Peace</a>” – a part volunteering, part national service programme that has been run in Bhutan for the last decade and has 4,500 members. These guardians encouraged people to get vaccinated and helped manage vaccine centres.</p>
<h2>Set a good example</h2>
<p>Good leadership has also been a hallmark of Bhutan’s vaccine rollout. There are <a href="https://www.theatlantic.com/international/archive/2021/02/coronavirus-pandemic-bhutan/617976/">high levels of trust</a> in the country’s political leaders. This has been helped during the pandemic by the government having two doctors and two public health experts in its <a href="https://www.cabinet.gov.bt/the-cabinet/">11-member cabinet</a>. The prime minister and the health minister have spent substantial time on the national response to COVID-19.</p>
<p>The role of King Jigme Khesar Namgyel Wangchuck should also not be underestimated. While Bhutan became a <a href="https://www.britannica.com/topic/constitutional-monarchy">constitutional monarchy</a> in 2008, transitioning to having a democratically elected government, the king is still much revered. His presence has been felt throughout the country, as he has travelled to remote settlements to oversee protection measures. </p>
<p>One such journey was a <a href="https://www.reuters.com/world/asia-pacific/bhutan-king-treks-across-mountains-hold-down-covid-19-fatality-count-2021-06-25/">five-day trek</a> to meet and thank healthcare workers. Leading by example, he quarantines in a hotel whenever he returns to the capital.</p>
<p>Bhutan’s politicians also <a href="https://www.ajtmh.org/view/journals/tpmd/104/2/article-p441.xml">engaged with the public</a> to overcome vaccine hesitancy. A survey studied the public’s concerns, with the government’s response focusing on communicating the science behind the vaccine. <a href="http://www.moh.gov.bt/update-our-gyenkhu-6/">Uptake was promoted</a> by social media influencers and television and film personalities.</p>
<p>Cultural sensitivity was also crucial to ensuring public support. For example, <a href="https://www.economist.com/graphic-detail/2021/04/08/bhutan-vaccinated-almost-all-its-adults-against-covid-19-in-a-week">Buddhist monks</a> determined when to roll the vaccines out and picked the most auspicious time (the majority of the population is Buddhist). Monks also determined that the first dose should be administered by a women and given to a women born in the Year of the Monkey.</p>
<figure class="align-center ">
<img alt="Two Buddhist monks walking over a bridge" src="https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&rect=188%2C197%2C2806%2C1841&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423546/original/file-20210928-17-1n136n2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The speed of the rollout didn’t compromise efforts to make it compatible with Buddhist customs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-young-monks-walking-on-puna-1099642451">Wantanee Chantasilp/Shutterstock</a></span>
</figcaption>
</figure>
<p>Not every country can achieve what Bhutan has. Having a small population and high trust in authorities facilitated this rollout. But Bhutan demonstrates that a fast and equitable vaccine rollout is possible in low and middle-income countries.</p>
<p>What’s clear is that the international community has to work together on the provision of vaccines. Support may also be needed to manage distribution, as getting doses to remote parts of the world’s least developed countries is a huge challenge. Bhutan, though, should offer encouragement that meeting it is possible.</p><img src="https://counter.theconversation.com/content/168341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Careful planning enabled this small, mountainous Himalayan country to vaccinate 90% of its adult population in three weeks.Sarah Schiffling, Senior Lecturer in Supply Chain Management, Liverpool John Moores UniversityChris Phelan, Senior Lecturer in Business and Management, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1668872021-08-28T04:21:40Z2021-08-28T04:21:40ZNational Cabinet leaves us in the dark about reopening the nation, so we’re left joining the dots<p>National Cabinet <a href="https://www.pm.gov.au/media/national-cabinet-statement-53">met on Friday</a> after a week of intensifying debate about the vaccination thresholds in the <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">national plan for reopening</a> the nation. </p>
<p>While expectations for the meeting were high, there was no showdown — at least as far as we know. </p>
<p>The current plan is <a href="https://theconversation.com/opening-with-70-of-adults-vaccinated-the-doherty-report-predicts-1-5k-deaths-in-6-months-we-need-a-revised-plan-166659">vague</a>, with words such as “may occur” and only subject to “in principle” agreement. </p>
<p>And the <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">Doherty Institute modelling</a>, which underpins the plan, acts as a fig leaf for the Commonwealth government to hide behind. So the plan has survived to live another day. </p>
<p>Deferring the day of reckoning has papered over the cracks. National Cabinet is holding tight for another week and awaiting further modelling. </p>
<p>A decision to hold tight is likely a compromise between the three factions in the virtual meeting room. But it leaves many questions unanswered.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/opening-with-70-of-adults-vaccinated-the-doherty-report-predicts-1-5k-deaths-in-6-months-we-need-a-revised-plan-166659">Opening with 70% of adults vaccinated, the Doherty report predicts 1.5K deaths in 6 months. We need a revised plan</a>
</strong>
</em>
</p>
<hr>
<h2>We have three factions</h2>
<p><strong>1. Commonwealth and NSW</strong></p>
<p>In one faction, you have the Commonwealth and New South Wales, both committed to easing restrictions according to the vaccination thresholds set out in the Doherty report: 70% and 80% of the population aged 16 and over. </p>
<p>Prime Minister Scott Morrison probably wanted to hold firm. After repeated <a href="https://theconversation.com/is-the-covid-vaccine-rollout-the-greatest-public-policy-failure-in-recent-australian-history-164396">failures to hit his vaccine rollout targets</a>, he cannot afford another change in the plan.</p>
<p>At the same time, NSW Premier Gladys Berejiklian has probably recognised she has lost the fight to control COVID in her state and wants political cover to claim victory. She has already announced the <a href="https://www.theguardian.com/australia-news/2021/aug/26/more-than-1000-covid-cases-a-day-in-nsw-and-we-are-told-we-can-have-a-picnic-welcome-to-the-future">easing of some minor restrictions</a> for fully vaccinated people.</p>
<p><strong>2. Other states handling NSW leaks</strong></p>
<p>In the second faction, you have states such as Queensland and Victoria affected by leaks of COVID cases from NSW. </p>
<p>These states would have wanted the modelling to reassure them their health systems would not be overwhelmed if they started to ease strong public health measures at low vaccination thresholds. </p>
<p><strong>3. COVID-zero states</strong></p>
<p>The third faction comprises the COVID-zero states, such as Western Australia, which would be concerned about any heightened risk of COVID leakage from other states. </p>
<p>These states only see <a href="https://thewest.com.au/news/coronavirus/wa-premier-unmoved-on-borders-lockdowns-c-3695364">downsides</a> from easing restrictions too early, when not enough people are vaccinated. They do not want to throw away the benefits of their hard-won COVID-zero status.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1431389679840940037"}"></div></p>
<h2>How to broker peace?</h2>
<p>To reconcile these conflicting positions, the leaders found peace in process: they decided to seek more information. </p>
<p>They agreed to establish a cross-jurisdictional working group, led by the heads of health departments, to investigate health and hospital system capacity and workforce needs in the next phases of the national plan.</p>
<p>This work will draw on the Doherty modelling, which shows many deaths will occur months after lockdowns end. </p>
<p>The group is due to report back by next week, presumably taking into account rapid advances in <a href="https://theconversation.com/were-seeing-more-covid-patients-in-icu-as-case-numbers-rise-that-affects-the-whole-hospital-165966">our understanding</a> of how <a href="https://ad996812-f908-4f9a-ae29-44e0df5347d5.filesusr.com/ugd/4e5c71_cc113a0bc7e54713a4d5443140234dd5.pdf">Delta might impact our health systems</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1431384707212533762"}"></div></p>
<p>The other states will not want to replicate the makeshift responses NSW was forced into — <a href="https://www.smh.com.au/politics/nsw/hotspot-hospitals-to-triage-covid-19-patients-in-makeshift-units-to-manage-surge-20210825-p58lum.html">such as triage tents to assess patients</a> — because of escalating hospital admissions.</p>
<p>This process may provide a way out for the Commonwealth. At the moment, states are highlighting the impacts of the Commonwealth’s failures on slow vaccination rollouts. But they could be brought around by a big-enough payment to compensate for the increased pressure reopening could put on their hospital systems.</p>
<p>As former Prime Minister Paul Keating <a href="https://www.dailytelegraph.com.au/news/opinion/all-riled-up-over-an-empty-bucket/news-story/93c0bff6a075170852189ba9a7480365">said</a>, “never get between a premier and a bucket of money”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1426173148249030660"}"></div></p>
<p>States will also need more Pfizer doses. At the moment, the lion’s share of the available Pfizer doses is going to NSW, leaving GPs in other states — especially Victoria — <a href="https://www.theage.com.au/national/victoria/victoria-in-talks-over-extra-shots-mulls-gp-payments-to-boost-rollout-20210826-p58m8o.html">scrambling to find doses</a> to meet demand. </p>
<p>Although these side-deals will not mean the states come out ahead, at least, financially, they will not be so far in the red.</p>
<h2>How about the Doherty modelling?</h2>
<p>As the National Cabinet’s behind-the-scenes negotiations were going on, the Doherty Institute <a href="https://www.pm.gov.au/media/national-cabinet-statement-53">reconfirmed its recommendation</a> of the 70% and 80% (adult population) vaccination thresholds. It continues to undertake further modelling, including specification of public health measures in areas of low vaccination coverage. </p>
<p>While the thresholds may not have changed, further modelling is yet to show how Australia’s rapidly rising COVID-19 case numbers impact the phasing, and the substance, of the plan.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1429246985396264961"}"></div></p>
<p>For instance, specific policy measures, such as exempting vaccinated people from restrictions, must be incorporated into the modelling, since vaccinated people can still spread the virus. </p>
<p>What privileges are extended to fully vaccinated people — holders of a <a href="https://www.abc.net.au/news/science/2021-08-23/covid-19-vaccine-certificates-forged-in-10-minutes/100390578">validated</a> vaccine passport — will be one of the next big challenges for the states, both politically and in terms of implementation and monitoring.</p>
<h2>How does vaccinating 12 to 15-year-olds fit in?</h2>
<p>National Cabinet’s meeting took place the same day the Australian Technical Advisory Group on Immunisation (ATAGI) <a href="https://www.health.gov.au/news/atagi-statement-on-the-use-of-covid-19-vaccines-in-all-young-adolescents-in-australia">recommended vaccination for 12 to 15-year-olds</a>, to begin on September 13.</p>
<p>But there were no updates to the national plan to include this age group as part of the total population vaccinated. The plan’s targets are still expressed as a proportion of the population aged 16 and over, rather than of the population soon eligible to be vaccinated, those aged 12 and over.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-vaccinate-children-against-covid-19-we-asked-5-experts-165316">Should we vaccinate children against COVID-19? We asked 5 experts</a>
</strong>
</em>
</p>
<hr>
<p>This means 12 to 15-year-olds are completely missing from the plan. It makes no sense for the nation to track progress towards vaccination targets without including this group.</p>
<p>Any plan to ease restrictions must also consider the <a href="https://www.theaustralian.com.au/nation/covid19-we-owe-it-to-ourkids-to-get-theschools-open/news-story/c98fc39019db2728cb2685fb21481da7">impact on children and their education</a>, especially for those under 12, who are not expected to be vaccinated this year.</p>
<h2>What next?</h2>
<p>While National Cabinet might be holding tight, there is still much work to be done to fill the many gaps in the current plan. We still need a robust national plan all states can sign up to, without hedging or caveats.</p><img src="https://counter.theconversation.com/content/166887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment from each of the Federal and Victorian Governments, BHP Billiton, and NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities as disclosed on its website. Grattan Institute has published three Reports on COVID issues, and has developed models which simulate the pandemic and the impacts of opening up at various population vaccination rates.</span></em></p><p class="fine-print"><em><span>Anika Stobart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Brokering peace among the factions appearing in National Cabinet will be key to a successful transition to reopening Australia. But there are many gaps in the plan.Stephen Duckett, Director, Health and Aged Care Program, Grattan InstituteAnika Stobart, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1664252021-08-23T05:46:53Z2021-08-23T05:46:53ZHigh priority: why we must vaccinate children aged 12 and over now<figure><img src="https://images.theconversation.com/files/417324/original/file-20210823-23-1j404lh.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C6709%2C4446&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>People <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/covid-19-vaccination-program-for-16-to-39-year-olds">aged 16 and above</a> will soon be able to get a COVID vaccine in Australia, but this begs the question: what about children in younger age groups?</p>
<p>Currently, only 12-15 year olds with underlying medical conditions, Aboriginal and Torres Strait Islander children, and those living in remote communities are <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/pfizer-covid-19-vaccine-approved-for-at-risk-children-aged-12-15-years">eligible</a>. </p>
<p><a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">Modelling</a> by the Doherty Institute has suggested vaccinating 12-15 year olds would not make a material difference to the COVID epidemic.</p>
<p>However, as a researcher with expertise on modelling infectious diseases, it’s my view children aged 12 and over must be vaccinated with high priority.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-may-need-to-vaccinate-children-as-young-as-5-to-reach-herd-immunity-with-delta-our-modelling-shows-164942">We may need to vaccinate children as young as 5 to reach herd immunity with Delta, our modelling shows</a>
</strong>
</em>
</p>
<hr>
<h2>Children and transmission</h2>
<p>A key concept you might have heard about is the reproduction number — the number of new cases per infectious case. For the Delta strain, this number could be <a href="https://www.theguardian.com/commentisfree/2021/aug/20/it-might-not-feel-like-it-as-cases-rise-but-nsw-is-controlling-delta">as high as nine</a>. In other words, if there were no lockdowns or other controls in place, each Delta infection could theoretically lead to as many as nine new infections.</p>
<p>The “effective reproduction number” is how many new cases you get per infectious case <em>after</em> public health measures such as lockdowns have been applied. </p>
<p>The Doherty modelling used a baseline effective reproduction number of 3.6 but acknowledges the effective reproduction number will be different from state to state. It can also change over time.</p>
<p>The effective reproduction numbers in NSW and Victoria are currently under two — but this figure could rise when lockdowns lift.</p>
<p><a href="https://theconversation.com/we-may-need-to-vaccinate-children-as-young-as-5-to-reach-herd-immunity-with-delta-our-modelling-shows-164942">Modelling</a> by colleagues and I shows that once the value of the effective reproduction number creeps up above four, all else being equal, children including those younger than 16 start to feature highly in transmission.</p>
<p>In other words, we need to vaccinate children aged 12 and above now, in preparation for a scenario when the effective reproduction number is much higher than it has been under lockdowns.</p>
<h2>A reality check</h2>
<p>In a scenario where children aged 12 and above are returning to school and moving around the community unvaccinated, could masks and social distancing be enough? </p>
<p>Well, perhaps in an ideal world. But many simply assume children will be able to socially distance and wear masks just like adults do. Parents may wish to reflect on that. </p>
<p>We also need to compare old assumptions about COVID and children with what we are now seeing in reality. </p>
<p>The original strain of COVID-19 appeared to spare children; they were less likely than older people to be infected in the first place. The Delta strain seems to have <a href="https://theconversation.com/should-we-vaccinate-children-against-covid-19-we-asked-5-experts-165316">changed</a> all that.</p>
<p>According to <a href="https://www.nsw.gov.au/covid-19/find-the-facts-about-covid-19">NSW Health</a>’s factsheet on coronavirus disease in NSW, only one person under 20 has died due to COVID. However, people in this age group are showing up significantly in overall case numbers. </p>
<p>Since NSW began its current lockdown, <a href="https://data.nsw.gov.au/search/dataset/ds-nsw-ckan-3dc5dc39-40b4-4ee9-8ec6-2d862a916dcf/details?q=">about one third of new COVID</a> cases in NSW (around 3,000) have been in under 20 year olds.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=237&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=237&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=237&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=298&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=298&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417319/original/file-20210823-21-1xe4fo0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=298&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">According to NSW Health, only one person under 20 has died due to COVID but people in this age group are showing up significantly in overall case numbers.</span>
<span class="attribution"><a class="source" href="https://www.nsw.gov.au/covid-19/find-the-facts-about-covid-19">NSW Health</a></span>
</figcaption>
</figure>
<p>Victoria’s chief health officer has also noted childcare centres and schools feature heavily <a href="https://www.dhhs.vic.gov.au/covid-19-chief-health-officer-update#update-outbreaks">among the hotspots in that state</a>.</p>
<p>If Delta does end up infecting children more than the original strain did, children may become the super-spreaders of the Delta variant — just as they are key transmitters of influenza, pertussis, measles, chicken pox and just about every respiratory virus.</p>
<p>Now, some expert groups — <a href="https://www.theaustralian.com.au/nation/politics/how-to-stop-spread-of-covid19-delta-variant-jab-all-teenagers/news-story/7287ea97986dcaff39125c4cb7b3ca55">including modellers</a> — are starting to call for younger children to be vaccinated with high priority. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1428814688154832897"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-vaccinate-children-against-covid-19-we-asked-5-experts-165316">Should we vaccinate children against COVID-19? We asked 5 experts</a>
</strong>
</em>
</p>
<hr>
<h2>Which vaccine? While Pfizer is scarce, we should direct it to younger people</h2>
<p>While Pfizer is scarce, we should be providing Pfizer to the younger population (who are <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">more likely</a> to <a href="https://theconversation.com/we-may-need-to-vaccinate-children-as-young-as-5-to-reach-herd-immunity-with-delta-our-modelling-shows-164942">transmit COVID-19</a>), while giving AstraZeneca to older people. </p>
<p>While both vaccines are over 90% effective at reducing death and severe outcomes from COVID (including Delta), <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2108891">Pfizer is better than AstraZeneca at reducing transmission</a> of the virus.</p>
<p>In Australia, children 12-17 are approved to receive Pfizer but not AstraZeneca. </p>
<h2>What are the consequences of not vaccinating younger children?</h2>
<p>The risks of not vaccinating children in the 12+ age group include:</p>
<ul>
<li><p>more children becoming sick with COVID</p></li>
<li><p>denying children potential freedoms that may come with vaccination, such as returning to school, travel or avoiding strict lockdowns</p></li>
<li><p>not vaccinating children means living with the knowledge we haven’t done everything possible to ensure they don’t transmit COVID to more vulnerable people.</p></li>
</ul>
<p>It’s unlikely Australia will achieve herd immunity to COVID this year. </p>
<p>But even without herd immunity, every little bit helps — and the growing number of cases in younger children suggests we need to vaccinate this group sooner, rather than later.</p><img src="https://counter.theconversation.com/content/166425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emma McBryde receives funding from the NHMRC and the MRFF. She previously worked for the Doherty Institute. </span></em></p>Not vaccinating children means living with the knowledge we haven’t done everything possible to ensure they don’t transmit COVID to more vulnerable people.Emma McBryde, Professor of Infectious Disease and Epidemiology, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645512021-08-16T04:26:12Z2021-08-16T04:26:12Z‘Don’t leave the esky in the sun’: how to get cold vaccines to hot, remote Australia<figure><img src="https://images.theconversation.com/files/416139/original/file-20210814-27-iq6h8f.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/off-road-track-outback-683939944">from www.shutterstock.com</a></span></figcaption></figure><p>There’s a <a href="https://www.9news.com.au/national/coronavirus-update-nsw-pfizer-covid-vaccine-shipment-for-walgett-and-other-regional-towns-in-lockdown/78193137-f185-420e-b6d1-88a3f18aa7a2">rush to vaccinate</a> vulnerable remote Aboriginal communities in New South Wales after spread of the coronavirus out of metropolitan areas has led to a state-wide lockdown.</p>
<p>So focus is turning to how quickly we can get COVID-19 vaccines over vast distances, far from vaccine warehouses in the cities, into remote Australians’ arms.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1425758379201290246"}"></div></p>
<p>But transporting vaccines to remote Australia isn’t new. Nor are the challenges that must be overcome to keep vaccines at the right temperature on the long and bumpy journey to remote clinics. </p>
<p>Here are some of the practical issues nurses, Aboriginal and Torres Strait Islander health practitioners, community health workers, pharmacists and others face when vaccines are transported vast distances by road, air or on water.</p>
<h2>It’s a long way</h2>
<p>The vast distances and isolated communities of remote Australia pose significant challenges to transporting vaccines. Then there are the environmental extremes, with freezing winter nights and scorching summer days, plus monsoonal rains and cyclones often interrupting transport services and making regions inaccessible for weeks. </p>
<p>Keeping vaccines at the right temperature over large distances, over days and weeks, can be challenging. But vaccines are temperature-sensitive products, and their effectiveness is dependent on correct storage. If a vaccine is too hot or too cold it may be damaged and not work as well.</p>
<p>So it’s critical to keep vaccines at the right temperature to ensure their safety and efficacy.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1403230641064497153"}"></div></p>
<p>For non-COVID vaccines and the <a href="https://www.health.nsw.gov.au/Infectious/covid-19/vaccine/Pages/az-refrigerator-to-administration.aspx">AstraZeneca COVID vaccine</a>, the recommended cold chain — between 2°C and 8°C — must be maintained from the place of manufacture to administration in the community.</p>
<p>However, transport and storage requirements for the Pfizer COVID vaccine are different. Unopened vials of the vaccine <a href="https://www.tga.gov.au/media-release/wider-storage-and-transportation-conditions-pfizer-covid-19-vaccine-now-approved">need to be stored</a> and transported at domestic freezer temperatures, between -25°C and -15°C, for up to two weeks. </p>
<p>Unopened vials may also be stored at domestic refrigerator temperatures, between 2°C to 8°C, for up to five days. Once a Pfizer vaccine has thawed it should not be re-frozen.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cracking-the-cold-chain-challenge-is-key-to-making-vaccines-ubiquitous-99329">Cracking the cold chain challenge is key to making vaccines ubiquitous</a>
</strong>
</em>
</p>
<hr>
<p>Keeping vaccines <a href="https://www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5">in the recommended temperature range</a> over long distances often means styrofoam boxes and regular eskies are inadequate, particularly when the transit time is likely to be three to four days. Transporting vaccines to remote Australia requires special infrastructure, including dedicated <a href="https://www.health.gov.au/health-topics/immunisation/health-professionals/storing-handling-and-administering-vaccines">vaccine fridges and insulated containers</a>.</p>
<p>If there’s a cold-chain breach, when vaccines are exposed to temperatures outside the recommended range, the vaccines may become damaged and might need to be thrown away and replaced. </p>
<p>Such breaches are estimated to have cost the Australian health system <a href="https://www1.racgp.org.au/newsgp/clinical/tip-of-the-cold-chain-iceberg-vaccines-worth-26-mi">at least A$25.9 million</a> in replacement vaccines over a five-year period. This estimate is pre-COVID, so the figure is likely higher if we take into account any cold-chain breaches with COVID vaccines.</p>
<p>There is a significant risk <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.1996.tb01084.x">of this happening</a> in remote Australia.</p>
<h2>All staff need to be aware</h2>
<p>All staff involved in the vaccination process, from manufacture to transport to administration, must understand the need to <a href="https://www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5">maintain the cold chain</a> and the risks associated with cold chain breaches. </p>
<p>This includes knowing the correct way to pack the vaccines in an insulated container (such as a vaccine cold box, esky or styrofoam box), using temperature monitors, and what to do when there’s a cold-chain breach.</p>
<p>However, there are few training materials dealing with vaccine cold chain in remote Australia. And with high staff turnover, it’s difficult to know everyone in the chain has the right training.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-urgently-need-to-get-vaccinated-but-are-not-being-consulted-on-the-rollout-strategy-164067">First Nations people urgently need to get vaccinated, but are not being consulted on the rollout strategy</a>
</strong>
</em>
</p>
<hr>
<h2>We made a video</h2>
<p>A team at Flinders University collaborated with Irene Nangala — a Pintupi elder and director of Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation (<a href="https://www.purplehouse.org.au">Purple House</a>), an Aboriginal community controlled organisation in Alice Springs — to make a short educational video called Vaccine Story.</p>
<p>The video depicts the journey a vaccine takes from a supply centre to a remote Australian community in a culturally appropriate manner. </p>
<p>This freely available video is especially useful for non-clinical staff, who may not otherwise receive professional training or updates.</p>
<figure>
<iframe src="https://player.vimeo.com/video/338754911" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Vaccine Story follows an esky full of vaccines from the city to remote Australia.</span></figcaption>
</figure>
<h2>Transport is important</h2>
<p>The video also looks at the importance of transport in maintaining the cold chain, especially in the “last mile” of <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2100574">vaccine logistics</a>. </p>
<p>For remote Australia, variable and unreliable transport add extra logistical challenges. Freight to remote communities is often limited with infrequent or non-existent services. </p>
<p>So local clinics and supply centres need to be adaptable and resourceful to ensure vaccine supply. The right transport option for one day might not be the best for another. Staff need to ask:</p>
<ul>
<li><p>is there a bus travelling to the community today?</p></li>
<li><p>can the visiting specialist team take the esky with them on the plane?</p></li>
<li><p>can the patient-transport driver pick up the vaccine from the pharmacy?</p></li>
<li><p>how are the roads today?</p></li>
</ul>
<p>Each of these options presents new challenges. Non-clinical staff may have to be trained in how to handle vaccines and the importance of maintaining the cold chain. </p>
<p>For example, the esky needs to be safely secured in the car. If it bounces around, the ice bricks may come into direct contact with the vaccines, which can cause them to freeze (the vaccines are generally separated from the ice with packing materials).</p>
<p>Staff will have to consider the temperature in a car, bus, the hull of a plane or on a barge. Vaccines will have to be handed over to the right person, not left on the runway or on the clinic doorstep in the sun.</p>
<p>There must be good lines of communication so everyone knows where the vaccines are.</p>
<h2>The electricity’s out</h2>
<p>Vaccines need to be stored in dedicated vaccine fridges when they reach the clinic in remote Australia.</p>
<p>However, challenges in maintaining the cold chain don’t stop there. It’s common in remote communities for <a href="https://www.theguardian.com/australia-news/2020/mar/04/power-outages-leave-aboriginal-people-on-nt-islands-with-no-food-fuel-or-phones-for-three-days">electricity outages</a> that mean vaccine fridges go off. Clinic staff <a href="https://www.remotephcmanuals.com.au/">need to be trained</a> in <a href="https://www.health.gov.au/sites/default/files/documents/2020/04/national-vaccine-storage-guidelines-strive-for-5.pdf">how to manage</a> these situations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
</strong>
</em>
</p>
<hr>
<h2>It’s a long road</h2>
<p>Despite these significant logistical challenges, vaccines have been successfully shipped to remote Australia for years before COVID vaccines became urgently needed.</p>
<p>But with the latest COVID cases in remote NSW, we’re reminded just how different the vaccine cold chain is in the bush compared with the city.</p>
<p>So all eyes are on looking after this precious cargo, including maintaining the cold chain.</p><img src="https://counter.theconversation.com/content/164551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tobias Speare received funding from Northern Territory PHN to create Vaccine Story video.</span></em></p><p class="fine-print"><em><span>Suzanne Belton is employed by CARPA to evaluate the Vaccine Story film. </span></em></p>Millions of dollars worth of vaccines are thrown out each year because they are not transported or stored at the right temperature. We made a video to help prevent that.Tobias Speare, Lecturer, Pharmacy Academic, Rural and Remote Health NT, Flinders UniversitySuzanne Belton, Associate professor, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1650742021-08-13T05:54:10Z2021-08-13T05:54:10ZMedia and politicians often defer to the AMA on COVID policies. But what role should the doctors’ group have in the pandemic?<p>Almost every day in recent months, Australian Medical Association (AMA) president Dr Omar Khorshid <a href="https://www.ama.com.au/media">has appeared in the media</a>, commenting on various issues related to the coronavirus pandemic. </p>
<p>These include changing recommendations about the use of the <a href="https://www.ama.com.au/media/ama-says-astrazeneca-vaccine-critical-combat-growing-covid-19-delta-outbreak">AstraZeneca vaccine</a>, urging the New South Wales government to <a href="https://www.ama.com.au/media/ama-calls-stricter-lockdown-greater-sydney-region">institute tighter lockdown</a> measures, and welcoming National Cabinet’s <a href="https://www.ama.com.au/gpnn/issue-21-number-26/articles/ama-welcomes-national-cabinet-roadmap-opening">roadmap out of the pandemic</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1424906970516000778"}"></div></p>
<p>The <a href="https://www.ama.com.au/media">raft</a> of AMA media releases, doorstops, and television and radio slots goes beyond the pandemic to expressing concerns about <a href="https://www.ama.com.au/media/climate-emergency-must-not-be-ignored">climate change</a> and doctors in <a href="https://www.ama.com.au/media/doctors-must-stop-being-targeted-myanmar">Myanmar</a>. Khorshid even outlined the AMA’s <a href="https://www.ama.com.au/vision-for-australias-health">Vision for Australia’s Health</a> at the <a href="https://www.ama.com.au/media/dr-omar-khorshid-national-press-club-amas-vision-australias-health">National Press Club address</a> in June.</p>
<p>Why is the AMA so regularly deferred to by politicians and media alike? And what is its role in the pandemic?</p>
<h2>Historically, it has protected doctors’ professional and financial interests</h2>
<p>The AMA (and its predecessor, the British Medical Association) built its reputation as a powerful, aggressive lobby group – essentially a medical union. It’s focused on protecting doctors’ professional interests and financial autonomy, and preserving the status quo in health care. </p>
<p>The self-published volume to commemorate the AMA’s 50th anniversary – ironically titled “<a href="https://www.ama.com.au/sites/default/files/documents/a_history_of_the_ama.pdf">More than Just a Union</a>” – boasts of efforts to forestall government attempts to make health care universal and affordable. </p>
<p>The <a href="https://independentaustralia.net/politics/politics-display/health-ministers-may-be-in-office-but-seldom-in-power,11258">most egregious</a> of these was the relentless <a href="https://theconversation.com/the-ama-and-medicare-a-love-hate-relationship-36346">opposition to the introduction</a> of the Pharmaceutical Benefits Scheme, Medibank and then Medicare.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-ama-and-medicare-a-love-hate-relationship-36346">The AMA and Medicare: a love-hate relationship</a>
</strong>
</em>
</p>
<hr>
<p>Underpinning this opposition was a fear of controls and interference by both governments and health insurers, and efforts to expand the scope of practice for health-care providers other than doctors. </p>
<h2>How the AMA has shaped past health policies</h2>
<p>Those past fears are echoed today in the AMA’s continuing opposition to a range of proposals that are seen as impinging on doctors’ autonomy. </p>
<p>These include resistance to payment mechanisms that would move from <a href="https://www.ama.com.au/media/ama-speech-ama-president-aprof-brian-owler-private-healthcare-australia">fee-for-service</a> (an itemised fee charged for every visit) to <a href="https://www.ama.com.au/position-statement/ama-position-statement-medical-home">capitated fees</a> for ongoing care of a chronic condition. </p>
<p>Concerns about the adequacy of doctors’ <a href="https://www.ama.com.au/sites/default/files/documents/AMA_Indexation_Freeze_Gaps_Poster_2016_0.pdf">Medicare rebates</a> are ongoing and, in some cases, justified. These concerns have led to the AMA issuing its own <a href="https://feeslist.ama.com.au/">fee guidance</a> to doctors.</p>
<p>The AMA has a particular aversion to “<a href="https://www.ama.com.au/media/ama-redoubles-efforts-stop-honeysuckle-and-nib-introducing-us-style-managed-care">US-style managed care</a>” which it <a href="https://www.theguardian.com/australia-news/2021/jun/25/doctors-fear-new-health-services-buying-group-will-create-us-style-care-in-australia">describes as</a> “a recipe for cost-cutting and less choice”. The AMA fears Medicare and private health insurers will try to push doctors, hospitals and patients into coercive contracts with capped funding payments, and require defined standards for <a href="https://www.surgeons.org/en/News/media-releases/racs-backs-ama-calls-to-block-us-style-managed-care-coming-to-australia">performance, quality and outcomes</a>.</p>
<p>Meanwhile, the AMA has consistently pushed back on increasing the roles for <a href="https://www.ama.com.au/sites/default/files/documents/australian_medicine_issue_24.15_august_20_2012.pdf">midwives</a> and <a href="https://www.ama.com.au/gp-network-news/ama-calls-nurse-practitioner-proposals-be-rejected">nurse practitioners</a> in the health-care system, and is <a href="https://ajp.com.au/news/pharmacies-using-patients-as-cash-cows-says-ama/">vehemently opposed</a> to pharmacists having an increased prescribing role.</p>
<figure class="align-center ">
<img alt="A nurse shows a doctor a patient file." src="https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415773/original/file-20210812-27-9ono7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The AMA has opposed nurses doing work traditionally done by doctors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/professional-nurses-looking-through-some-patients-1180808089">Shutterstock</a></span>
</figcaption>
</figure>
<p>Yet the AMA has also played a significant leadership role in highlighting <a href="https://www.ama.com.au/advocacy-policy?ac=Policy%20Statement">important issues</a> as varied as Indigenous health, tobacco and vaping regulation, boxing injuries, treatment of refugees, and climate change.</p>
<h2>Inside the AMA machine</h2>
<p>The AMA’s federal secretariat has excellent resources to assist with this work – experts in policy development, economic analysis and communications. This is highlighted in the <a href="https://www.ama.com.au/advocacy-policy?ac=Report%20Card#results">report cards</a> it regularly issues, which have the capacity and status to influence public opinions and government policy.</p>
<p>The AMA is diligent about making sure its voice is heard with <a href="https://www.ama.com.au/media/federal-budget-must-invest-health">budget commentary</a> and <a href="https://www.ama.com.au/advocacy-policy?ac=Submission#results">submissions</a> to a range of enquiries and reports. According to the AMA website, in 2020 it made 45 submissions – a mammoth task of preparation and approval.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/patient-advocate-or-doctors-union-how-the-ama-flexes-its-political-muscle-60444">Patient advocate or doctors' union? How the AMA flexes its political muscle</a>
</strong>
</em>
</p>
<hr>
<p>This latter task is never easy for the AMA. It is an inherently conservative body, more comfortable with the conservative side of politics, although this has varied with the public face of the president. </p>
<p>Internal infighting was conspicuously highlighted when Dr Michael Gannon, in his successful 2016 run for AMA presidency, <a href="https://www.news.com.au/national/western-australia/ama-seeks-to-close-political-wounds-with-election-of-michael-gannon-as-president/news-story/48ec0bb87d182639d62eeffa4ad3a9e2">chided</a> then-president Dr Brian Owler for <a href="https://theconversation.com/the-ama-and-medicare-a-love-hate-relationship-36346">opposing</a> funding cuts in health in the 2014-15 Budget and the medical treatment of asylum seekers. </p>
<p>Gannon <a href="https://www.news.com.au/national/western-australia/ama-seeks-to-close-political-wounds-with-election-of-michael-gannon-as-president/news-story/48ec0bb87d182639d62eeffa4ad3a9e2">said</a>:</p>
<blockquote>
<p>The criticism that is made of the current leadership [of the AMA] is that it’s strong on progressive policies but not listened to by the conservative government.</p>
</blockquote>
<p>Ultimately, these in-house conflicts undermine the effectiveness of the organisation’s loud public voice. It can agree with or oppose government proposals, but is rarely able to generate enough internal consensus to offer alternatives. </p>
<p>All this serves to cast the AMA today as something of a chameleon organisation trying to be all things to all people. On the one hand, it’s always at war with government (regardless of political party) over members’ interests. On the other hand, it elevates issues of social responsibility and <a href="https://www.ama.com.au/about">publicly positions</a> itself as seeking to advance community health. </p>
<p>We see this dichotomy playing out in the pandemic. Along with supportive words to the public and comments on governments’ actions, the AMA is raising the usual concerns and is “<a href="https://www.ama.com.au/article/update-novel-coronavirus-covid-19">working tirelessly</a>” to shore up its influence in the corridors of power.</p>
<h2>How the AMA is using its influence in the pandemic</h2>
<p>It is likely the AMA’s influence on the federal government led to the initial decision to roll out the vaccination of the general public primarily through GPs. </p>
<p>The AMA <a href="https://www.ama.com.au/gpnn/issue-21-number-9/articles/local-gps-lead-roll-out-covid-19-vaccines">highlighted</a> that rolling out the campaign through general practice was the best way to encourage the community to get vaccinated and noted “<a href="https://www.ama.com.au/ama-rounds/12-february-2021/articles/gps-not-pharmacists-best-placed-vaccine-rollout">significant reservations</a>” about the role of pharmacists in the vaccine rollout.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1358971753834311681"}"></div></p>
<p>This follows <a href="https://practices.hotdoc.com.au/blog/flu-vaccine-turf-war/">years of opposition</a> to pharmacists playing a role in the flu vaccinations rollout, as you can see in this media release from 2014: </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415755/original/file-20210811-13-gtenyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.ama.com.au/media/ama-questions-safety-pharmacy-vaccinations">AMA media release screenshot</a></span>
</figcaption>
</figure>
<p>But many busy GP practices were unable to gear up for COVID-19 vaccinations and initially they were unable to manage the storage requirements for the Pfizer vaccine. These were later <a href="https://www.tga.gov.au/behind-news/tga-approves-more-flexible-storage-conditions-pfizer-biontech-covid-19-vaccine#:%7E:text=Behind%20the%20news-,TGA%20approves%20more%20flexible%20storage,Pfizer%2DBioNTech%20COVID%2D19%20vaccine&text=On%20Monday%2024%20May%202021,on%20Thursday%20May%2020%2C%202021.">modified</a> and <a href="https://www.ama.com.au/gpnn/issue-21-number-22/articles/gps-deliver-pfizer-vaccine">since June</a> practices can apply to also administer the Pfizer vaccine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/grattan-on-friday-we-will-need-an-inquiry-to-learn-from-rollout-mistakes-165696">Grattan on Friday: We will need an inquiry to learn from rollout mistakes</a>
</strong>
</em>
</p>
<hr>
<p>Responding to questions The Conversation’s political correspondent <a href="https://theconversation.com/grattan-on-friday-we-will-need-an-inquiry-to-learn-from-rollout-mistakes-165696">Michelle Grattan raised last week</a> about how the AMA shaped the vaccine rollout, Dr Khorshid said the program was slowed by “supply constraints and hesitancy due to changing advice”: </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1423441375203266560"}"></div></p>
<p>In recent weeks, we have seen how both GPs and pharmacists are needed to ramp up
vaccine delivery, especially in <a href="https://www.smh.com.au/national/nsw/pharmacies-are-ready-to-go-chemists-in-hotspots-fast-tracked-to-deliver-jabs-20210715-p58a1i.html">coronavirus hotspots</a>.</p>
<p>On other issues, the AMA has been very supportive of the expanded telehealth services that were put in place early in the pandemic to allow patients to have a consultation with their doctor by video or phone. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">What can you use a telehealth consult for and when should you physically visit your GP?</a>
</strong>
</em>
</p>
<hr>
<p>Initially these consultations were required to be bulk billed, but the AMA has now persuaded the government to <a href="https://www.ama.com.au/gpnn/issue-20-number-38/articles/government-agrees-ama-proposal-mbs-telehealth-extension">remove this requirement</a>. This means patients whose doctors do not bulk bill will now have out-of-pocket costs for telehealth consultations. </p>
<p>Meanwhile, AMA media releases also credit the organisation for proposing the government’s yet-to-be-implemented vaccine indemnity scheme. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409706247431983105"}"></div></p>
<h2>Striving for relevance and public trust</h2>
<p>The AMA is driven by the need to demonstrate relevance to today’s cohort of doctors and the public in the face of increasing competition for members and attention.</p>
<p>When the federal AMA was formed in 1962, <a href="https://medicalrepublic.com.au/low-can-ama-go/14216#:%7E:text=In%201962%2C%20more%20than%2095,notes%20a%20membership%20of%2029%2C425.">95%</a> of doctors were members. As of 2018 it was <a href="https://medicalrepublic.com.au/low-can-ama-go/14216#:%7E:text=In%201962%2C%20more%20than%2095,notes%20a%20membership%20of%2029%2C425.">less than 30%</a>. </p>
<p>The specialist colleges have captured many doctors and most GPs belong to the <a href="https://www.racgp.org.au/">Royal Australian College of General Practitioners</a> (RACGP) and/or the <a href="https://www.acrrm.org.au/">Australian College of Rural and Remote Medicine</a>.</p>
<p>So it’s no surprise the RACGP is also an active player on behalf of its members – the advocacy pages of its <a href="https://www.racgp.org.au/">website</a> show it claims some of the same policy victories as the AMA. Its president is also a <a href="https://www.racgp.org.au/gp-news/media-releases/2021-media-releases/july-2021/racgp-governments-must-clarify-vaccine-eligibility">frequent media presence</a> on the pandemic and other issues. </p>
<p>Many of Australia’s problems with vaccine rollout and compliance with lockdowns are due to confusing communication strategies from governments and the poor quality of public education campaigns. There is certainly room for effective communicators, speaking in language that everyone understands, to step into this space.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/just-the-facts-or-more-detail-to-battle-vaccine-hesitancy-the-messaging-has-to-be-just-right-155953">Just the facts, or more detail? To battle vaccine hesitancy, the messaging has to be just right</a>
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<p>The public sees doctors as <a href="https://7news.com.au/lifestyle/poll-finds-doctors-most-trusted-profession-c-2704423">trusted voices</a> and doctors working at the coalface are uniquely placed to comment on the health-care consequences of the pandemic. </p>
<p>The AMA (and other medical organisations) have spent decades building access to media and politicians. This means that often their voice is heard above those who have more expertise and their concerns are more obvious than those of affected communities. This is a privileged situation that should be used for public good, ahead of any organisational self-interest, during the pandemic and in the years ahead. </p>
<hr>
<p><em>Editor’s note: The Conversation contacted the AMA for a response and in a statement, Dr Omar Khorshid said, “the issues the AMA advocates on are in the interests of doctors, the wider health professions, and patients”. He said these issues “go to the heart of our healthcare system and all health professionals, including nurses”.</em></p><img src="https://counter.theconversation.com/content/165074/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The AMA has shaped some important decisions in the pandemic, but it’s not always clear how its power is used.Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655372021-08-10T05:25:07Z2021-08-10T05:25:07ZWhat do I need to know about the Moderna vaccine? And how does it compare with Pfizer?<p>Australia’s medical regulator has <a href="https://www.tga.gov.au/media-release/tga-provisionally-approves-modernas-covid-19-vaccine-0">provisionally approved</a> another COVID-19 vaccine, Moderna, for use in Australia. </p>
<p><a href="https://www.pm.gov.au/media/moderna-covid-19-vaccine-approved-use-australia">One million doses</a> of Moderna are due in the second half of September and three million doses a month will begin to arrive from October. </p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/australias-vaccines-boosted-with-provisional-approval-for-moderna-165820">Australia's vaccines boosted with provisional approval for Moderna</a>
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<p>Like Pfizer, Moderna is an mRNA vaccine. So how does it work, and what are the similarities and differences with Pfizer? </p>
<h2>Remind me, how do mRNA vaccines work?</h2>
<p>mRNA is a temporary genetic instruction that tells our cells to make a particular protein. It consists of a central portion with the genetic code for the protein and shorter portions either side that are important for the “readability” of the code.</p>
<p>The mRNA is wrapped in an oily coat that helps it enter our cells. The mRNA gets broken down quite quickly after it is delivered and used.</p>
<p>The Pfizer and Moderna vaccines were designed with the same goals and principles: to make an mRNA (genetic instruction) for the spike protein found on the surface of the SARS-CoV-2 virus (which causes COVID-19). </p>
<figure class="align-center ">
<img alt="A SARS-CoV-2 virus with red spike proteins." src="https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415343/original/file-20210810-25-1h7r08u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The SARS-CoV-2 virus is covered in spike proteins, shown here in red.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendering-covid19-virus-05-1677546550">Shutterstock</a></span>
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</figure>
<p>Body cells near the vaccine injection site will make the spike protein, display it on their surface and trigger the immune system to learn how to fight the actual virus if it encounters it.</p>
<h2>Do Pfizer and Moderna work any differently?</h2>
<p>The vaccines are remarkably similar overall, with just a few technical differences. The two mRNAs are based on the same chemistry and produce the same spike protein variant. </p>
<p>But the mRNA sequences differ in two ways: the exact “wording” of the genetic code for the spike protein; and the shorter portions outside the actual genetic code that determine its “readability”. </p>
<p>The two companies also use different oily coatings in their formulations. </p>
<h2>How many doses for Moderna? And how far apart?</h2>
<p>Despite their similarities, the Moderna doses have <a href="https://www1.racgp.org.au/newsgp/clinical/four-things-about-mrna-covid-vaccines-researchers">more than three times the amount</a> of mRNA material (100 micrograms), compared to Pfizer (30 micrograms). </p>
<p>The dose spacing is also different: three weeks apart for Pfizer and four weeks for Moderna. </p>
<p>These differences may be due to those small technical differences highlighted above.</p>
<p>Alternatively, given the great urgency of developing and trialling the vaccines, it’s also plausible both manufacturers ran out of time to fully test different formulations and timelines, and simply went with the amounts and spacing that produced the desired results. </p>
<h2>How effective is Moderna at preventing COVID-19?</h2>
<p>Large phase 3 clinical trials showed the <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2035389">Moderna vaccine was 94%</a> effective at preventing severe disease, and <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2034577">Pfizer</a> was 95% effective. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-the-moderna-covid-vaccine-does-it-work-and-is-it-safe-160859">What is the Moderna COVID vaccine? Does it work, and is it safe?</a>
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<p><a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">Newer studies</a> based on real-world data of millions of vaccinated people in many countries have shown Moderna and Pfizer vaccines are:</p>
<ul>
<li>80-90% effective at preventing asymptomatic infection</li>
<li>90% effective at preventing symptomatic infection </li>
<li>95% effective at preventing hospitalisation. </li>
</ul>
<p>The Moderna vaccine has been approved for emergency use in many countries including the United States, many European Union countries, Canada, the United Kingdom, Israel and India, among others. </p>
<p>Several studies, only some of which have been peer-reviewed, indicate both <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2108891">Pfizer</a> and <a href="https://www.medrxiv.org/content/10.1101/2021.06.28.21259420v1.full.pdf">Moderna</a> vaccines are highly effective against the Delta variant, although there is a slight reduction compared to the original viral strain. </p>
<h2>Are there any side effects?</h2>
<p>Both vaccines have some side effects common to most vaccines, including some soreness at the injection site, fatigue and headaches. </p>
<p>There is an association, but not a causal link between a slight increase in <a href="https://www1.racgp.org.au/newsgp/clinical/studies-link-myocarditis-cases-to-mrna-vaccines">incidence of myocarditis</a> (inflammation of heart muscle) and pericarditis (inflammation of the lining of the heart) with both Pfizer and Moderna vaccines. </p>
<p>These conditions are more common in young men and are <a href="https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601">generally treatable</a> and not fatal; most patients make a swift recovery. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-benefits-of-a-covid-vaccine-far-outweigh-the-small-risk-of-treatable-heart-inflammation-163970">The benefits of a COVID vaccine far outweigh the small risk of treatable heart inflammation</a>
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<p>For both Moderna and Pfizer vaccines the rates of anaphylaxis (extreme allergic reaction) are similar, and <a href="https://jamanetwork.com/journals/jama/fullarticle/2776557">extremely low</a> (two to four cases per million).</p>
<h2>How long does the immunity last?</h2>
<p><a href="https://www.reuters.com/business/healthcare-pharmaceuticals/moderna-says-its-covid-19-shot-remains-93-effective-4-6-months-after-second-dose-2021-08-05/">Moderna recently announced</a> no change in efficacy six months after participants received their COVID-19 vaccines, with a 93% protection against severe disease after six months, compared to 94% reported in the clinical trial. </p>
<p>Pfizer has reported similar data, with protection sitting at <a href="https://www.wsj.com/articles/pfizer-vaccines-protection-against-covid-19-declines-after-six-months-but-remains-high-11627508816">84% after six months</a>. </p>
<p>No longer term effectiveness studies have been possible, as the wide-scale vaccine rollout only commenced at the end of 2020. </p>
<h2>What about storage and transport?</h2>
<p>Moderna <a href="https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/downloads/storage-summary.pdf">requires</a> a -50°C to -15°C range during transport and long-term storage (until the expiration date is reached) and this can be achieved with standard freezers. </p>
<p>In contrast, the Pfizer vaccine <a href="https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/storage-summary.pdf">needs</a> to be transported and stored at temperatures below -60°C, needing dry ice and ultra-cold freezers. Then, undiluted Pfizer vaccine can be stored in a regular freezer (between -25°C and -15°C) for up to two weeks, or in a fridge (between 2°C and 8°C) for up to four weeks.</p>
<h2>How much Moderna is coming to Australia?</h2>
<p>Moderna is approved for use in adults aged 18 and over. Australia’s medicines regulator, the Therapeutic Goods Administration (TGA) is <a href="https://www.theage.com.au/politics/federal/moderna-vaccine-gets-provisional-approval-in-australia-20210809-p58h9p.html">currently reviewing</a> an application from Moderna to approve the vaccine’s use in children aged 12 and over. </p>
<p><a href="https://www.pm.gov.au/media/moderna-covid-19-vaccine-approved-use-australia">Prime Minister Scott Morrison says</a> planning is underway for Moderna vaccines to be rolled out through approved pharmacies and other providers from September, after the government receives advice from its immunisation advisory group ATAGI. </p>
<p>Ten million Moderna doses will arrive during 2021: one million in the second half of September and nine million doses due by December. </p>
<p>That compares with <a href="https://www.smh.com.au/national/what-do-the-vaccine-reopening-targets-mean-and-when-is-all-the-pfizer-arriving-20210802-p58f1h.html">plans to roll out</a> four million Pfizer doses in September, ten million in November and six million in December.</p>
<p>Next year, 15 million Moderna doses are due to arrive; these will be reserved as booster shots. A further <a href="https://www.pm.gov.au/media/australia-secures-additional-pfizer-biontech-vaccine-2022-and-2023">60 million Pfizer doses</a> will also be available in 2022. </p>
<p>It’s likely Australians in eligible groups will be offered either Moderna or Pfizer and given their similarities, it really doesn’t matter which one you have – they’re both very effective.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-the-pfizer-or-moderna-mrna-vaccines-affect-my-genetic-code-162590">Can the Pfizer or Moderna mRNA vaccines affect my genetic code?</a>
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<img src="https://counter.theconversation.com/content/165537/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Archa Fox receives funding from the NHMRC and ARC. She is a member of the Australian and New Zealand RNA Production Consortium. </span></em></p><p class="fine-print"><em><span>Thomas Preiss receives funding from NHMRC and ARC. He is a member of the Australian and New Zealand RNA Production Consortium.</span></em></p>Doses of the Moderna vaccine will be available in Australia from mid-September. So if you’re in an eligible group you could be offered either Pfizer or Moderna. Here’s how they compare.Archa Fox, Associate Professor and ARC Future Fellow, The University of Western AustraliaThomas Preiss, Molecular biologist, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1656582021-08-06T05:08:54Z2021-08-06T05:08:54ZWe can’t rely solely on arbitrary vaccination levels to end lockdowns. Here are 7 ways to fix Sydney’s outbreak<figure><img src="https://images.theconversation.com/files/414930/original/file-20210806-13-briyt7.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4941%2C3301&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Mick Tsikas/AAP</span></span></figcaption></figure><p>On July 15, New South Wales Premier Gladys Berejiklian <a href="https://www.abc.net.au/news/2021-07-15/nsw-covid-community-infections-still-too-high-at-28/100294900">said</a> Sydney’s COVID lockdown wouldn’t end until the number of new cases not in full isolation was zero or as close to zero as possible.</p>
<p>But by August 1 the premier’s message had <a href="https://www.smh.com.au/politics/nsw/berejiklian-says-vaccination-milestones-will-be-key-to-ending-lockdown-20210801-p58euz.html">shifted</a>:</p>
<blockquote>
<p>Once you get to 50% vaccination, 60%, 70% it obviously triggers more freedoms […] The challenge for us is to get as many people vaccinated in August as possible so that by the time August 28 comes around, we have a number of options before us as to how we can ease restrictions.</p>
</blockquote>
<p>There are around five million Australians under 16 who aren’t eligible to be vaccinated (bar a few groups of 12-15-year-olds whom the Australian Technical Advisory Group on Immunisation (ATAGI) <a href="https://www.health.gov.au/news/atagi-statement-regarding-vaccination-of-adolescents-aged-12-15-years">said</a> this week should be prioritised for vaccination, including Aboriginal and Torres Strait Islanders and those with certain underlying health conditions). </p>
<p>So, vaccinating 50% of the eligible population represents only about 40% of the whole population. Vaccinating 70% of the eligible population means only 56% of the whole population are vaccinated.</p>
<p>There can be no relaxation options determined solely by vaccination rates of 50% or even 70% of the eligible population. We cannot give up on our safety by pretending these vaccination rates in over-16s during an insufficiently controlled COVID outbreak would be like “living with the flu”. It won’t be.</p>
<p>Relaxing lockdown prematurely based solely on an arbitrary (and much too low) vaccination rate will likely lead to escalating cases and impose huge costs on Sydney and the rest of Australia.</p>
<p>Having not gone early, hard and fast, we propose seven key actions to save Sydney. </p>
<p>Crucially, Sydney’s lockdown needs to continue until the number of new daily cases who weren’t in full isolation reaches zero.</p>
<h2>What does 70% of the eligible population vaccinated mean for Australia?</h2>
<p>The premier’s August 1 announcement was similar to the federal government’s <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">National Transition Plan</a> released on July 30. The plan states that when 70% of Australians over 16 are vaccinated, governments should “ease restrictions on vaccinated residents”, and that lockdowns will be “less likely but possible”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaccination-rate-needs-to-hit-70-to-trigger-easing-of-restrictions-165407">Vaccination rate needs to hit 70% to trigger easing of restrictions</a>
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<p>As we’re seeing in <a href="https://www.abc.net.au/news/2021-08-02/south-east-qld-schools-reduce-onsite-staff-during-lockdown/100342934">Southeast Queensland now</a>, Delta <em>is</em> acquired and transmitted by children. This means only vaccinating 70% of over-16s will leave our kids vulnerable to COVID outbreaks. In the absence of public health measures, these children will pass it on to their friends and families. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1423125022198034439"}"></div></p>
<p>While the risk of death from COVID, even with Delta, is lower among children than adults, there’s still a risk of long-term health consequences called “long COVID” among the young (and old). </p>
<p>Researchers <a href="https://www.nature.com/articles/d41586-021-01935-7">dispute how common long COVID is</a> in kids. But a <a href="https://onlinelibrary.wiley.com/doi/10.1111/apa.15870">study</a> of children in Italy who have had COVID reported more than half had at least one symptom lasting more than four months, and more than 40% had a health problem due to long COVID that impaired their daily activities.</p>
<p>A UK survey of 23,000 households, published online as a preprint in June, <a href="https://www.medrxiv.org/content/10.1101/2021.05.28.21257602v1">found</a> 5% of children infected with COVID had suffered persistent post-COVID symptoms for longer than four weeks.</p>
<h2>What could happen if Sydney’s lockdown is relaxed too soon?</h2>
<p>As of August 6, and since the Delta outbreak began in Sydney on June 16, there have been 4,610 locally acquired cases and 22 deaths. On August 6 there were 304 people hospitalised, 50 in intensive care with 22 requiring ventilation.</p>
<p>Using <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Pages/stats-nsw.aspx">these stats</a>, we can estimate what might happen should there be a partial relaxation of the current Sydney lockdown after 70% of over-16s in Greater Sydney are fully vaccinated and the outbreak is still ongoing. </p>
<p>First, if the vast majority of new daily cases aren’t in full isolation while infectious when lockdown restrictions are relaxed, this could easily result in a rapid growth in infections. This is because Delta is highly transmissible — infected people develop a viral load <a href="https://www.medrxiv.org/content/10.1101/2021.07.07.21260122v2">on average 1,000 times higher</a> than the original strain. Even with new daily case numbers much lower than the numbers in early August, contact tracing wouldn’t be an effective secondary prevention strategy.</p>
<p>Let’s say partial relaxation after August 28 resulted in rapid and uncontrolled growth of new cases. We estimate that over a few months, and in the absence of subsequent lockdowns, this could result in as many as 100,000 cumulative hospitalisations, a total of more than 10,000 COVID patients in intensive care and, tragically, thousands of deaths in Greater Sydney alone.</p>
<p>This assumes that in an uncontrolled spread, eventually all unvaccinated people become exposed to COVID. We based these figures on the current ratios of how many people in Sydney have been hospitalised and died from COVID from the total number of cases, multiplied these numbers by the unvaccinated population, and extrapolated these numbers forward in the scenario of an uncontrolled outbreak.</p>
<p>Based on <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252400">our previous research</a>, the minimum economic cost of those hospitalisations (ignoring lost wages and the costs of “long COVID” and ongoing care generally) in Greater Sydney could easily exceed half a billion dollars. The economic costs from the expected loss of life would be in the tens of billions.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-we-cant-treat-covid-19-like-the-flu-we-have-to-consider-the-lasting-health-problems-it-causes-164072">No, we can’t treat COVID-19 like the flu. We have to consider the lasting health problems it causes</a>
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<h2>7 ways to fix Sydney’s outbreak</h2>
<p>Experience from Australia and around the world tells us what needs to be done to protect public health and the economy.</p>
<p>NSW must:</p>
<ol>
<li><p>ensure Sydney’s lockdown continues beyond August 28 until the number of new daily cases who aren’t in full isolation reaches zero</p></li>
<li><p>focus on daily testing of essential and front-line workers so pre-symptomatic and asymptomatic workers are identified before they enter the workplace. NSW should use the very best <a href="https://www.bmj.com/content/374/bmj.n1676">rapid test technology</a>. Essential workers can be quickly and easily screened at a fraction of the cost and time of the standard PCR test</p></li>
<li><p>ensure everyone in lockdown gets adequate financial support to stay home, including those on visas. This is much more cost-effective than having those struggling financially not get tested and go to work, get infected and possibly spread COVID</p></li>
<li><p>actively minimise leakage to rural NSW, including setting up a “ring of steel” around Greater Sydney. This should include checking essential services drivers are up to date with daily rapid testing and measures to prevent other travellers from leaving </p></li>
<li><p>make masks mandatory outdoors as well as indoors (outside the home) throughout Greater Sydney</p></li>
<li><p>maintain the focus on increasing the vaccination rate among Sydneysiders by taking vaccinations to essential workplaces</p></li>
<li><p>recognise that until Sydneysiders, including children, have had the opportunity to be fully vaccinated then stringent lockdowns will need to be implemented rapidly whenever there are uncontrolled outbreaks of COVID.</p></li>
</ol><img src="https://counter.theconversation.com/content/165658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Quentin Grafton has received funding from the Australian Research Council for his research. However, he has received no funding from any source in relation to his COVID-19 modelling or research.</span></em></p><p class="fine-print"><em><span>Mary-Louise McLaws is a member of the World Health Organization Health Emergencies Ad Hoc COVID-19 Infection Prevention and Control Guidance Discussion Group </span></em></p><p class="fine-print"><em><span>Tom Kompas has received funding from the Australian Research Council for his research. However, he has received no funding from any source in relation to his COVID-19 modelling or research.</span></em></p>NSW needs to mandate masks outdoors, provide adequate financial support, set up a ‘ring of steel’, use rapid tests for essential workers, and ensure cases not in full isolation get to zero, among others.Quentin Grafton, Australian Laureate Professor, Crawford School of Public Policy, Australian National UniversityMary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW SydneyTom Kompas, Professor of Environmental Economics and Biosecurity, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1656032021-08-05T05:27:56Z2021-08-05T05:27:56ZAustralia’s vaccination plan is 6 months too late and a masterclass in jargon<figure><img src="https://images.theconversation.com/files/414718/original/file-20210805-5434-jg7keo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C624&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/rows-multiple-covid19-vaccine-vials-flag-1952554525">from www.shutterstock.com</a></span></figcaption></figure><p>Six months after the prime minister <a href="https://www.abc.net.au/news/2021-02-21/australia-covid-vaccinations-begin-first-shots-administered/13176288">received his first jab</a>, Australia finally has a national plan to roll out COVID vaccines.</p>
<p>The plan’s goals, set out in the Operation COVID Shield <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/op-covid-shield-national-covid-vaccine-campaign-plan.pdf">document released this week</a>, are to ensure public confidence in the vaccine rollout and to get as many Australians as possible vaccinated as early as possible. </p>
<p>The plan looks to reach the vaccination targets set out in modelling from the Doherty Institute and <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-30-july-2021.pdf">announced after national cabinet</a>.</p>
<p>That would aim to have 80% of eligible Australians fully vaccinated by the end of the year. This figure has been criticised by some experts as <a href="https://theconversation.com/national-cabinets-plan-out-of-covid-aims-too-low-on-vaccinations-and-leaves-crucial-questions-unanswered-165447">too low</a>. On this basis alone the plan is short-term and arguably short-sighted.</p>
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<p>Media reports about the plan have so far focused on the prospect of <a href="https://amp.sbs.com.au/eds/news/article/national-covid-19-vaccine-plan-proposes-drive-through-clinics-within-months/ab45e988-f3f9-4ab6-b198-e3f438ed24af">drive-through vaccination clinics</a>, <a href="https://www.theaustralian.com.au/news/latest-news/lieutenant-general-john-frewen-does-not-rule-cash-incentives-to-entice-people-to-get-vaccinated/news-story/1c73f270e80c87790b3b78917961d54d">incentives to vaccinate</a> and the <a href="https://www.theguardian.com/australia-news/2021/aug/05/dentists-midwives-and-physiotherapists-could-deliver-covid-jabs-to-bolster-australias-rollout">possible enrolment of</a> dentists, midwives and physiotherapists to help vaccinate.</p>
<p>But, as the plan admits, there is no exhaustive detail for any of these initiatives, and in particular for how to reach the vaccination target. And any substance competes with jargon and sloganeering. </p>
<p>At best this is an optimistic vision for an improved vaccination rollout that fails to acknowledge and fully address the errors of the past.</p>
<p>The man in charge, Lieutenant General John Frewen, <a href="https://www.health.gov.au/news/lieutenant-general-john-frewens-press-conference-on-4-august-2021">says</a>: “Mathematically, we can get there.”</p>
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Read more:
<a href="https://theconversation.com/national-cabinets-plan-out-of-covid-aims-too-low-on-vaccinations-and-leaves-crucial-questions-unanswered-165447">National Cabinet's plan out of COVID aims too low on vaccinations and leaves crucial questions unanswered</a>
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<h2>Coordinate, motivate and deliver</h2>
<p>The plan proposes three key elements for achieving its vision — coordinate, motivate and deliver — each of which comes with inherent problems.</p>
<p><strong>Coordinate</strong></p>
<p>Ramping up the vaccination rollout will require an unprecedented level of collaboration between the Commonwealth and the states, and with other stakeholders. That’s a no-brainer. </p>
<p>But national cabinet has only agreed “<a href="https://www.pm.gov.au/media/national-cabinet-statement-10">in principle</a>” to the prime minister’s plans, with more work to be done. If state and territory governments are not fully on board, then national coordination is impossible.</p>
<p><strong>Motivate</strong></p>
<p>Positive public sentiment and the willingness of Australians to get vaccinated are seen as the “centre of gravity”. </p>
<p>The plan defines this as “the primary entity that possesses the inherent capability to achieve the desired end state” for the plan. This language is a direct steal from the <a href="https://theforge.defence.gov.au/jmap-glossary#c">Australian Defence Glossary</a>.</p>
<p>The key new element in this section is setting up an “industry liaison cell” to coordinate messaging and to work with business.</p>
<p><strong>Deliver</strong></p>
<p>Arguably the real centre of gravity of the plan must be the ability to deliver vaccinations at times and locations that ensure jabs in people’s arms. If these commitments are not met, the “positive public sentiments” seen as so crucial to the “motivate” part of the plan will quickly become negative.</p>
<p>Some pretty heroic assumptions underpin the 19 million vaccine doses expected to be available in November (that’s 10 million Pfizer, 5 million AstraZeneca, 4 million Moderna).</p>
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<p>These assumptions include the willingness of Pfizer to <a href="https://www.abc.net.au/news/2021-07-09/australia-pfizer-doses-announcement-scott-morrison-vaccines/100280104">bring forward supplies</a> and the Therapeutic Goods Administration’s timely approval <a href="https://www.tga.gov.au/media-release/tga-grants-provisional-determination-moderna-covid-19-vaccine-elasomeran">of the Moderna vaccine</a>.</p>
<p>There is no explanation of how and why the vaccine numbers differ from an earlier <a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-covid-vaccination-allocations-horizons-covid-19-vaccination-covid-vaccination-allocations-horizons-19-june-2021.pdf">vaccination allocations document</a> in June.</p>
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Read more:
<a href="https://theconversation.com/here-are-9-ways-we-can-make-it-easier-for-australians-to-get-the-covid-19-vaccine-159219">Here are 9 ways we can make it easier for Australians to get the COVID-19 vaccine</a>
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<h2>Too complex</h2>
<p>The most striking feature of the plan is the array of new structures it imposes, such as new committees or “cells”. These are on top of the complicated array that already exists and the many stakeholders.</p>
<p>Frewen is the coordinator general of the <a href="https://www.pm.gov.au/media/national-cabinet-statement-040621">National COVID Vaccine Taskforce</a>, known as <a href="https://www.health.gov.au/initiatives-and-programs/operation-covid-shield/about-operation-covid-shield">Operation COVID Shield</a>. But there are many other hands on the tiller. He reports to the prime minister, the health minister, cabinet and the national cabinet. He must also work in partnership with the states and territories.</p>
<p>The taskforce now has streams to coordinate, motivate and deliver. It also oversees an “assessments cell”, which will analyse data and track progress of the vaccine rollout against targets. </p>
<p>There will also be a new “program governance committee” to oversee and advise the taskforce on managing key (unspecified) risks and achieving outcomes.</p>
<p>Then there are business stakeholders who will be looked after by the already mentioned new “industry liaison cell”.</p>
<p>This interesting addition will coordinate the allocation of vaccines to approved business partners, drive how businesses communicate about vaccination, and facilitate policy discussions relating to issues business raises. </p>
<p>This could help efficiently drive vaccinations in the workplace. But it’s easy to see how disruptive this could be if industry voices and needs are privileged over those of communities that may not have the government’s ear. </p>
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Read more:
<a href="https://theconversation.com/were-paying-companies-millions-to-roll-out-covid-vaccines-but-were-not-getting-enough-bang-for-our-buck-164550">We're paying companies millions to roll out COVID vaccines. But we're not getting enough bang for our buck</a>
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<h2>Will this work?</h2>
<p>Two issues highlight the potential problems ahead. </p>
<p>The first is the deliberate decision that a number of vulnerable population groups — including community carers, people in mental health facilities and immigration detention, the homeless and prisoners — are not included in this plan and responsibilities for their vaccinations will be left to current jurisdictions. This is unfair and untenable.</p>
<p>The second is the lack of insight into what has gone wrong with the vaccine rollout to date.</p>
<p>Ultimately, the only way to know if this <a href="https://www.smh.com.au/politics/federal/why-scott-morrison-brought-in-the-army-to-wargame-the-pandemic-response-20210630-p585jk.html">military-style campaign plan</a> will fight the pandemic war and defeat the coronavirus enemy is to marshal the troops, invoke a national call to arms, and begin the battle, adjusting the battle plan as needed.</p>
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Read more:
<a href="https://theconversation.com/calling-in-the-army-for-the-vaccine-rollout-and-every-other-emergency-shows-how-ill-prepared-we-are-162247">Calling in the army for the vaccine rollout and every other emergency shows how ill-prepared we are</a>
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<img src="https://counter.theconversation.com/content/165603/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Coordinate, motivate, deliver. That’s only the start of the jargon in Australia’s plan to vaccinate the nation.Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655402021-08-04T09:42:12Z2021-08-04T09:42:12ZWe need to start vaccinating people in their 20s and 30s, according to the Doherty modelling. An epidemiologist explains why<figure><img src="https://images.theconversation.com/files/414484/original/file-20210804-23-4tlv9d.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5568%2C3709&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Lukas Coch/AAP</span></span></figcaption></figure><p>Last week the federal government <a href="https://theconversation.com/vaccination-rate-needs-to-hit-70-to-trigger-easing-of-restrictions-165407">announced</a> 70% of over-16s would need to be vaccinated for COVID-19 restrictions to be eased.</p>
<p>And this week, Melbourne’s Doherty Institute <a href="https://www.doherty.edu.au/news-events/news/doherty-institute-modelling-report-for-national-cabinet">published the modelling</a> informing this. The Doherty Institute had been asked by national cabinet to model the effects of increasing vaccination rates on Australia’s pathway out of the COVID pandemic.</p>
<p>The collaboration created an impressive assembly of models that allows them to assess the impacts of outbreaks under a range of infection-control scenarios. The model can be adapted to explore easing of specific restrictions, or changed conditions, for example if the dominant variant changes, or our response is more or less effective than anticipated.</p>
<p>They found vaccinating 70% of over-16s would allow for lesser restrictions in the event of an outbreak, and getting to 80% would mean significant easing and likely no lockdowns.</p>
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Read more:
<a href="https://theconversation.com/vaccination-rate-needs-to-hit-70-to-trigger-easing-of-restrictions-165407">Vaccination rate needs to hit 70% to trigger easing of restrictions</a>
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<p>The ongoing need for interventions highlights how difficult it is to manage the Delta variant compared to previous strains. Even vaccinating 80% of the population over 16 still requires a level of active control in an outbreak setting, albeit with light restrictions.</p>
<p>The modelling uses Australian data <a href="https://www.health.gov.au/resources/collections/coronavirus-covid-19-common-operating-picture">gathered from across the country</a> since August last year. This includes data on “transmission potential”, which is effectively the average number of people one infected person is likely to infect. Under varying levels of public health responses and people’s compliance with restrictions, the modellers were able to estimate this reproduction rate of the virus to understand what it will take to get transmission potential below one, and keep it there, so infections don’t climb beyond manageable levels.</p>
<p>The modelling forecast extends out six months. This is actually a relatively long time horizon given how quickly things change in this pandemic. The parameters start to become unreliable beyond that, and therefore the reliability of forecasts wanes. The modelling is a very well informed best guess, but there are many uncertainties. The value here lies in comparing different scenarios to chart the most strategic course, rather than the specific number of ICU beds or cases predicted.</p>
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Read more:
<a href="https://theconversation.com/australia-shouldnt-open-up-before-we-vaccinate-at-least-80-of-the-population-heres-why-165073">Australia shouldn't ‘open up’ before we vaccinate at least 80% of the population. Here's why</a>
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<p>The modelling gives us a guide for the level of vaccination coverage we’ll need to control the virus. The 80% mark for those currently eligible delivers a level of protection that promises an escape from our current cycling between lockdowns. It also highlights that time is of the essence — we need to get there before new variants emerge.</p>
<p>If we stay in the current limbo, we’re at risk of community transmission becoming embedded in other states, repeating the New South Wales situation across Australia. </p>
<p>As vaccination rates increase, the need for heavy restrictions decreases, so vaccination is the path out of the limbo we’re in. </p>
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<h2>Why the focus on younger people?</h2>
<p>To date, Australia’s rollout has focused on those most at risk of severe outcomes from the disease, including older Australians, protecting them and our health-care systems from overload.</p>
<p>But to reach the vaccination targets in the most effective way, the modelling demonstrates the value in turning our focus now to reducing transmission.</p>
<p>Our highest transmission and case rates occur <a href="https://www.health.gov.au/resources/covid-19-cases-by-age-group-and-sex">in 20-39 year olds</a>. This group is the most mobile. They tend to socialise and mix with other people the most and therefore have the most close contacts on average. Many live in shared houses, have young families, and make up a large portion of the workforce, particularly essential workers. The Doherty Institute’s Professor Jodie McVernon <a href="https://www.abc.net.au/news/2021-08-03/scott-morison-doherty-institute-modelling-covid-vaccine-targets/100344760">said</a> people aged 20-29 in particular were “peak spreaders”.</p>
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<p>It’s vital we start vaccinating 20-39 year olds, because this approach gives a better bang for our vaccination buck.</p>
<p>Vaccinating this group protects not only them, but the whole population including those who can’t be vaccinated. Vaccinated people are less likely to become infected and, even if they do, less likely to pass it on. The Doherty Institute’s <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_including_adendmum.pdf">technical report</a> on the modelling indicates the combined effect is a reduction in transmission risk of 86% for AstraZeneca and 93% for Pfizer.</p>
<p>Professor McVernon <a href="https://youtu.be/ubD9BZQKaWw">said</a> vaccinating as many 20-39 year olds as possible could double the protection for over-60s, and protect everyone else, making it the most equitable strategy at this stage of our rollout.</p>
<h2>Why weren’t kids included?</h2>
<p>The Doherty Institute wasn’t asked to factor in vaccinating those younger than 16, so kids are treated as unvaccinated in the model. Their protection, and the protection of schools from the impact of outbreaks, therefore relies on adults reaching the 80% target, and parents in particular. </p>
<p>The risk here is that if the virus does find its way into schools, it might cause significant outbreaks that quickly spread across schools — like we’re seeing <a href="https://www.9news.com.au/national/coronavirus-queensland-update-latest-covid-19-case-numbers-august-3-children-vulnerable-to-virus-spread/ab412f35-47b5-43b0-ae44-52f4a295214b">in Queensland at the moment</a>. Stronger public health interventions might still be required to contain an outbreak.</p>
<p>We’ll have to monitor this closely over time, and as COVID vaccine trials in kids continue, to help us weigh up risks and benefits.</p>
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<p>This week, ATAGI <a href="https://www.health.gov.au/news/atagi-statement-regarding-vaccination-of-adolescents-aged-12-15-years">advised</a> kids aged 12-15 should be prioritised for vaccination if they’re Aboriginal or Torres Strait Islander, live in a remote community or have underlying medical conditions. </p>
<p>As overall vaccination rates rise, we need to look out for areas with low vaccination coverage. If the virus finds its way in, we may still see a degree of local transmission that requires restrictions. But in these instances, restrictions would be more localised and targeted rather than a whole city or state.</p>
<p>Australia’s Chief Medical Officer, Professor Paul Kelly, said it well in Tuesday’s press conference: we can aim for a “soft landing” where other countries can’t. The modelling tells us when we get to 80% adult vaccination coverage, we can avoid the huge wave of infections we’ve worked so hard to prevent.</p>
<p>Unlike the United Kingdom, where cases peaked again on reopening, or the United States, where cases and hospitalisations are both on the rise, we can leverage our past success in outbreak control and get through this without ever seeing a wave of a truly international proportions.</p><img src="https://counter.theconversation.com/content/165540/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Bennett receives funding from the National Health and Medical Research Council and The Medical Research Future Fund. Catherine is also an independent expert on the Covid-19 AstraZeneca Vaccine Advisory Board, Australia.</span></em></p>20-39 year olds are ‘peak spreaders’. If we vaccinate them, it reduces the risk for all of us.Catherine Bennett, Chair in Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648772021-08-03T15:23:35Z2021-08-03T15:23:35ZHow the private sector can support South Africa’s COVID-19 vaccine rollout<figure><img src="https://images.theconversation.com/files/414138/original/file-20210802-22-zjtdt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If South Africa continues vaccinating at current rates, it would take over two years to reach the targeted coverage of 67% of the population.</span> <span class="attribution"><span class="source">Darren Stewart/Gallo Images via Getty Images</span></span></figcaption></figure><p>South African president Cyril Ramaphosa recently announced the scaling up of the country’s COVID-19 vaccination rollout. At the beginning of September 2021, the entire adult population – people over 18 – will be eligible to get vaccinated. Around <a href="http://www.statssa.gov.za/publications/P0302/P03022021.pdf">40 million adults fall into this category</a>. This is an ambitious target and will take a concerted effort to achieve. </p>
<p>Indeed, in his <a href="https://sacoronavirus.co.za/2021/07/25/statement-by-president-cyril-ramaphosa-on-progress-in-the-national-effort-to-contain-the-covid-19-pandemic-25-july-2021/">address</a> on 25 July, Ramaphosa reaffirmed the government’s commitment to working with the private sector on achieving the target. </p>
<p>South Africa has a two-tier health system. The public sector is wholly funded by the government and serves the <a href="http://www.statssa.gov.za/publications/P0318/P03182018.pdf#page=37">majority</a> of the population. The private sector is partly funded by the state and by patients. Around <a href="http://www.statssa.gov.za/publications/P0318/P03182018.pdf#page=37">27%</a> of South Africans have access to private healthcare. But because official vaccine statistics are not split by sector, there is no way of accurately comparing the rollout efficiency of the public and private sectors. </p>
<p>What we do know is that the government is the <a href="https://www.nicd.ac.za/covid-19-vaccine-rollout-strategy-faq/">sole purchaser of vaccines</a>. It procures, distributes and oversees the rollout of the vaccine at vaccination centres, work-based programmes and outreach-based programmes.</p>
<p>Part of this function includes distribution to the private sector, which started rolling out vaccines shortly after the public sector on <a href="https://www.timeslive.co.za/news/south-africa/2021-05-14-covid-19-vaccine-rollout-will-begin-at-private-sector-sites-on-may-24/">24 May 2021</a>. </p>
<p>There’s been a <a href="https://www.businessinsider.co.za/the-number-of-people-vaccinated-against-covid-19-in-south-africa-rollout-2021-7">recent uptick in the vaccinations</a>. But one <a href="http://mediahack.co.za/datastories/coronavirus/vaccination-calculator/">estimate</a> shows that South Africa is averaging just under 46,000 vaccines a day. If the country continues vaccinating at this rate, it would take over two years to reach the targeted vaccine coverage of 67% of the population. The country cannot afford to wait this long and therefore the need to accelerate the rollout remains urgent. All hands should be on deck.</p>
<p>A swift and consistent vaccine rollout is critical to prevent <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01361-7">entrenchment of pre-existing health inequalities</a>.</p>
<p>The private sector’s <a href="https://businesstech.co.za/news/business/502373/a-message-to-ramaphosa-from-south-africas-biggest-private-employer/">willingness to quickly pick up the slack and additional costs</a> of the rollout is most likely driven by profit. But increasing coverage and accelerating the vaccine rollout would benefit society at large too.</p>
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Read more:
<a href="https://theconversation.com/healthcare-in-south-africa-how-inequity-is-contributing-to-inefficiency-163753">Healthcare in South Africa: how inequity is contributing to inefficiency</a>
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<h2>Expanding private sites</h2>
<p>More than 70% <a href="https://sacoronavirus.co.za/active-vaccination-sites/">(1,026 sites)</a> of the currently available vaccination sites are in the public sector. But the number of private sector sites <a href="https://sacoronavirus.co.za/active-vaccination-sites/">(324)</a> is growing steadily. The three main private sector players are the medical aid scheme <a href="https://www.discovery.co.za/corporate/vaccination-sites">Discovery</a>, and pharmacy chain groups <a href="https://clicks.co.za/covidvaccine">Clicks</a> and <a href="https://www.dischem.co.za/covid-19-vaccination">Dischem</a>. Members of the public can go to any site – public or private – without having to pay.</p>
<p>If the private sector can offer vaccinations more efficiently, then serious consideration should be given to expanding private sites at a faster rate. The counterargument to this is that private sites are not geared towards mass rollouts, unlike the public sector. This may result in bottlenecks at private sites during early phases of rollout, and <a href="https://twitter.com/search?q=vaccine%20queue%20clicks&src=typed_query&f=live">anecdotes suggest this has been the case</a>. Similar to the public sector, most vaccine sites in the private sector are also only open five days a week at the moment. </p>
<p>Given its supply chain infrastructure and networks, the private sector can take on a bigger coordinating role in the distribution of vaccines. An existing public-private partnership that works well is the <a href="https://getcheckedgocollect.org.za/ccmdd/">centralised chronic medicines dispensing and distribution</a> – also known as Dablap. State patients registered with the programme can collect their state-issued chronic medication from their most convenient pick-up point, be it in the community, public or private sector. A similar solution could be designed for the vaccine rollout. </p>
<p>Other <a href="https://businesstech.co.za/news/business-opinion/502579/medical-aid-boss-appeals-to-ramaphosa-let-the-private-sector-vaccinate-south-africa/">interesting solutions</a> have been suggested, such as vaccinating without registration on the government system. Another is procurement strategies that reduce the risk of using a dominant vaccine producer.</p>
<h2>Putting people first</h2>
<p>However, any plan that does not place the needs of people first, whether it involves the public or private sector or both, is bound to fail. This fact underscores the importance of partnering with communities in any vaccine rollout.</p>
<p>An example of a community-oriented innovation can be found in <a href="http://www.statssa.gov.za/?p=12075">Limpopo, the poorest province in the country</a>, which seems to be at the <a href="https://www.businessinsider.co.za/limpopo-province-the-first-to-reach-herd-immunity-in-south-africa-2021-6">forefront of reaching population immunity</a>. Much of its rapid progress has been attributed to including local churches and traditional leaders in the rollout plan. Communities seemed to trust local leaders and faith-based organisations more than healthcare professionals and politicians. Limpopo carried out large-scale door-to-door registration and vaccination in the most inaccessible, rural parts of the province with poor internet connectivity. As a result it overtook other provinces with rollout numbers. </p>
<p>In South Africa, it is the poorest and most vulnerable who struggle to access care and therefore have the worst health outcomes. The impact of a (possibly) two-year-long vaccine rollout – whether due to <a href="https://businesstech.co.za/news/business-opinion/502579/medical-aid-boss-appeals-to-ramaphosa-let-the-private-sector-vaccinate-south-africa/">supply side exclusion</a>, <a href="https://cramsurvey.org/wp-content/uploads/2021/07/2.-Burger-R.-Maughan-Brown-M.-Kohler-T.-English-R.-_-Tameris-M.-2021-Increased-openness-to-accepting-a-COVID-19-vaccine-is-a-shot-in-the-arm-for-South-Africa-Evidence-from-the-NIDS-CRAM-Wave-5-Survey.pdf">demand side hesitancy</a> and <a href="https://sacoronavirus.co.za/2021/07/13/media-release-impact-of-violent-protests-on-health-services/">unrest</a>, <a href="https://theconversation.com/south-africas-vaccine-quagmire-and-what-needs-to-be-done-now-163784">poor planning by government</a>, or <a href="https://www.sciencedirect.com/science/article/pii/S2666535221000215?v=s5">global vaccine power dynamics</a> – is likely to hit vulnerable subgroups the hardest.</p><img src="https://counter.theconversation.com/content/164877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carmen S. Christian has worked on research projects funded by the NRF and the Bill and Melinda Gates Foundation.</span></em></p>Any vaccine rollout plan that does not place the needs of people first, whether it involves the public or private sector or both, is bound to fail.Carmen S. Christian, Senior Lecturer, Department of Economics, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1650262021-07-23T10:15:04Z2021-07-23T10:15:04ZPfizer doses to be spaced out in NSW crisis, but state fails to get change in vaccination program<figure><img src="https://images.theconversation.com/files/412864/original/file-20210723-19-qtiquy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">AAP/Mick Tsikas</span></span></figcaption></figure><p>Pfizer doses in NSW will be spaced out to enable more first jabs to be administered quickly, as the Berejiklian government on Friday declared the Sydney COVID crisis a “national emergency”.</p>
<p>But the plea by the state for Pfizer doses to be diverted to Sydney as part of a refocusing of the national vaccine program has fallen on deaf ears.</p>
<p>Scott Morrison indicated if any extra Pfizer supplies became available they would be directed to NSW – but he made clear there would be no change in the national vaccination program.</p>
<p>“Where there is a potential to put more vaccines into NSW, even beyond what we’re already doing, well, of course, we will seek to do that. But we are not going to disrupt the vaccination program around the rest of the country,” he said after a meeting of the national cabinet.</p>
<p>Vaccines are distributed on a population basis, although NSW was recently given a special allocation of 300,000 doses, half AstraZeneca and half Pfizer.</p>
<p>Morrison also said suppression was the key immediate means of stopping community transmission and getting on top of the outbreak that is concentrated in south western Sydney. “Suppression is the primary tool to achieve that, and vaccines can help that.”</p>
<p>Earlier, General JJ Frewen, who is in charge of the vaccine rollout, was dismissive of the suggestion supplies be diverted.</p>
<p>“Vaccines are only one part of a response to the outbreak like this,” Frewen told a Senate committee.</p>
<p>Other states made it clear they would not give up any of their Pfizer supplies.</p>
<p>Morrison said extending the time between Pfizer doses – normally three weeks – to six weeks was within the advice of the Australian Technical Advisory Group on Immunisation (ATAGI). This would be done in NSW vaccination clinics.</p>
<p>He also said there was “agreement amongst the national cabinet that we need to continue to lean in to AstraZeneca, particularly in NSW”.</p>
<p>Australian Medical Association President Dr Omar Khorshid on Friday called on ATAGI to review its advice on AstraZeneca in response to the growing risks posed by the outbreak of the Delta variant in NSW.</p>
<p>“As we don’t have enough Pfizer to use in a targeted rollout, the only option is AstraZeneca. It will save lives and help see life return to some normality in Greater Sydney,” Khorshid said.</p>
<p>ATAGI has preferred Pfizer for those under 60, although it recently qualified its advice in light of the Sydney outbreak.</p>
<p>As NSW on Friday reported 136 new cases in the 24 hours to 8pm Thursday, Victorian Premier Daniel Andrews said “Sydney is on fire with this virus and we need a ring of steel put around Sydney”.</p>
<p>But Morrison said that at national cabinet Berejiklian had spelled out “in very specific detail the extensive lockdown” the state had in place.</p>
<p>“There’s nothing light about the lockdown in NSW – in Sydney, I can assure you. My family are in it,” he said.</p>
<p>At her news conference on Friday morning, Berejiklian said Chief Health Officer Kerry Chant and her team “advised us that the situation that exists now in NSW, namely around south-western and now western Sydney suburbs, is regarded as a national emergency.”</p>
<p>She appealed for the vaccination strategy to be redirected to south western Sydney, particularly to younger people who had to perform essential work such as the production of food.</p>
<p>She said there was a very young population in the affected communities, “and we need at least more first doses of Pfizer.”</p>
<p>Meanwhile, figures given to the Senate COVID committee showed only 47.2% of residential aged care workers had had a first vaccine dose and 27.8% had received their second dose. Vaccination has been made mandatory by September for these workers.</p><img src="https://counter.theconversation.com/content/165026/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite Premier Gladys Berejiklian declaring a state of emergency, her plea to divert extra vaccines to New South Wales have fallen on deaf ears.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1620912021-07-23T02:59:51Z2021-07-23T02:59:51ZEradicating smallpox: the global vaccination push that brought the world ‘arm-to-arm’<figure><img src="https://images.theconversation.com/files/412353/original/file-20210721-27-wcaw1d.jpeg?ixlib=rb-1.1.0&rect=18%2C2%2C859%2C731&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Edward Jenner vaccinating his son, held by Mrs Jenner; a maid rolls up her sleeve, a man stands outside holding a cow. Coloured engraving by C. Manigaud after E Hamman. The Wellcome Collection.</span></span></figcaption></figure><p>As the roll-out of COVID vaccines proceeds, it’s worth looking back on the challenges and successes of the early global spread of smallpox vaccination.</p>
<p>Smallpox (also known by its scientific name, variola) was a horrible, highly infectious disease, with a case fatality-rate of 30%. In 1798, Edward Jenner, an English country doctor, published data on cowpox (or “vaccine”, a term derived from the Latin for cow and increasingly preferred by Jenner; modern scientific name vaccinia). His data suggested this pustular disease found on dairy cows protected people from smallpox.</p>
<p>He detailed experiments in which he inoculated children with cowpox (usually by nicking the arm and inserting cowpox pus under the skin), and presented the inoculation of cowpox as a safe and effective way to prevent smallpox.</p>
<p>Jenner’s claims were initially met with scepticism. Even in Britain, vaccination was not taken up on any scale until 1800. By this time, though, cowpox samples were being dispatched overseas and attracting great interest as a way to protect people against smallpox. By 1805, at the height of the Napoleonic Wars, people were already being vaccinated all around the world. By 1815, several million people, half of them outside Europe, had been vaccinated.</p>
<p>Sadly, however, the global eradication of smallpox was not achieved until the late 1970s.</p>
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<h2>The wonder of cowpox</h2>
<p>Smallpox was universally feared but people had learned to live with it. It was easy enough to recognise; victims became visibly ill before they became infectious. Crucially, people knew that if they survived the attack, they could be confident of lifelong immunity.</p>
<p>Learning to live with smallpox sometimes involved deliberately exposing children to the disease in the hope of a mild outcome. In Britain, it was found smallpox inoculation — that is, making a light cut in the arm and applying smallpox pus to the wound — resulted in far fewer deaths than in cases of naturally acquired smallpox. </p>
<p>It was as a practitioner of smallpox inoculation (which was also known as variolation) that Jenner found evidence people who had been casually infected with cowpox appeared to be immune to smallpox infection. </p>
<p>He put the theory to the test by inoculating a boy with cowpox lymph — taken not from the cow but from a vesicle or blister on a milkmaid’s hand — and demonstrating his resistance to smallpox by variolation.</p>
<p>Jenner’s presentation of cowpox as a safe and effective substitute for smallpox found corroboration in trials in London in 1799. It wasn’t easy to allay doubts among parents. Still, people were even more scared of smallpox, and recognised smallpox inoculation involved significant risk to the patient and the community. Cowpox was a game-changer.</p>
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<h2>More diaspora than roll-out</h2>
<p>Although hailed as a boon, the new approach got off to a shaky start. Cowpox was rare, appearing only sporadically in dairy farms. The supply of vaccine depended from the outset on its propagation on human bodies. If the vaccine “took” on the child’s arm then, nine or ten days later, the ripe pustule was pricked to provide fresh vaccine. </p>
<p>Children of the poor were immunised at no charge and, on returning to clinics for examination, were put arm-to-arm with the next batch of children. Some vaccine was dried, often on cotton threads, as a future supply. Quality control was a major problem. In 1800, a cowpox institute was set up in London to propagate and distribute vaccine and in 1803 the Royal Jenner Society was established to promote the practice.</p>
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<a href="https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406916/original/file-20210617-27-z89ro6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Cowpox was a rare disease, appearing only sporadically in dairy farms.</span>
<span class="attribution"><span class="source">J. Pass, Public domain, via Wikimedia Commons</span></span>
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<p>The spread of the first vaccine was more diaspora than roll-out. Samples of cowpox on cotton threads were sent in the post, in Britain and overseas, rather in the manner of plant seeds. </p>
<p>Many samples proved useless on arrival, but by sending them in some profusion, it proved relatively simple to seed the practice in Europe and North America. Improvements in packaging even made it possible to send vaccine from Vienna to Baghdad, where it was propagated for onward transmission to India in 1802. Viable vaccine was even delivered, after a 154-day voyage, to Sydney in 1804. </p>
<h2>The world arm-to-arm</h2>
<p>Another approach to conquering the tyranny of distance was to move patients under vaccination. Early in 1802, Tsar Alexander approved an expedition to establish vaccination through Russia in which children vaccinated in one province were escorted to go “arm-to-arm” with children in the next. In 1803, King Carlos of Spain launched an even grander expedition that, by vaccinating a succession of children, delivered live vaccine to Spanish America and then across the Pacific to Manila and Macao.</p>
<p>Vaccination literally brought the world arm-to-arm. The rapid global spread of the vaccine itself owed a lot to the universal dread of smallpox but also to humanitarian enthusiasm and international collaboration. </p>
<p>A range of measures were used to embed the practice. In Berlin, children were given trinkets and medals. Poor mothers in Mexico and India were bribed to have their children vaccinated. In Austria, mothers whose children died of smallpox were named and shamed. </p>
<p>Some states moved rapidly along the road to compulsion. In France, where Napoleon was a great advocate of the practice, vaccination was urged as a civic duty but not made mandatory. In Denmark, a vaccination certificate was rapidly made a requisite for schooling, public employment and even marriage.</p>
<h2>Complacency and lack of resolve</h2>
<p>Aware of vaccine’s global success, Jenner and his colleagues deplored the loss of momentum in Britain itself. In London, the practice was under challenge from a noisy anti-vaccination lobby led by old-style inoculators. </p>
<p>A smallpox epidemic in 1805, while showing the value of vaccination, disclosed some failures arising from poor early practice. In claiming vaccination was for life, Jenner had set the bar too high. To the end of his life in 1823, he was reluctant to concede the need for periodic re-vaccination.</p>
<p>The major problem in Britain and elsewhere was complacency. The early success in suppressing smallpox, and indeed eliminating it in some places, led parents to neglect vaccination. </p>
<p>Outbreaks in the 1830s were a major shock and pushed the British government to fund vaccination in 1840 and to make it mandatory in 1853. Victoria — though not New South Wales — followed this lead. Although it was controversial and fuelled anti-vaccination sentiment, compulsory vaccination, with some provision for conscientious objection, played a vital role making the practice routine. This kept smallpox at bay, prompted improvements, and helped inspire the development of new vaccines.</p>
<p>From the outset, vaccination was seen as a means of eradicating smallpox. It saved countless lives, kept communities safe for as long as vaccination was maintained, and limited the severity of outbreaks. </p>
<p>The permanent elimination of smallpox required governments to provide the infrastructure and resources, and show the political will to incentivise if not mandate vaccination. </p>
<p>Although the disease was largely brought under control in the West, millions were still dying from smallpox elsewhere in the middle of the twentieth century when the World Health Organization committed itself to the global eradication of smallpox.</p>
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<p class="fine-print"><em><span>Michael Bennett has received support for his work on this topic from the Australian Research Council.
He is the author of War Against Smallpox. Edward Jenner and the Global Spread of Vaccination (Cambridge University Press, 2020).
</span></em></p>The major problem in Britain and elsewhere was complacency. The early success in suppressing smallpox, and indeed eliminating it in some places, led parents to neglect vaccination.Michael Bennett, Professor in School of History and Classics, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648532021-07-22T20:06:09Z2021-07-22T20:06:09ZWe’re losing the vaccination race because of bungling, not bad luck<figure><img src="https://images.theconversation.com/files/412603/original/file-20210722-23-1s1ezw4.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C2689%2C1319&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Eric Surprenant/Shutterstock</span></span></figcaption></figure><p>As one big international competition begins, another one is nearing its end. At least we hope so. </p>
<p>I am, of course, talking about the Tokyo Olympic Games and the international roll-out of vaccines against COVID-19.</p>
<p>Australia has been in the top ten in the medal tally at every summer Olympics since 1992. It is projected to again be near the top in Tokyo – certainly on a per-capita basis. </p>
<p>But in the vaccination standings, we are near the bottom of the OECD league.</p>
<p>When it comes to COVID vaccines, Australia has had a shocker. With apologies to the late legendary sports broadcaster <a href="https://www.abc.net.au/news/2016-09-11/legendary-abc-broadcaster-norman-nugget-may-dies/7820584">Norman May</a>, no one would be exclaiming: “Gold! Gold to Australia! Gold!” </p>
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<figcaption><span class="caption">Australia wins the Men’s 4x100 meter medley relay at the 1980 Olympics.</span></figcaption>
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<p>Things are not going swimmingly. If this were a 4x100 metre medley relay, our team would involve the backstroker jumping into the diving pool, the breaststroker veering into the wrong lane, the butterfly swimmer breaking, and the freestyle anchor swimmer sinking.</p>
<p>Unlike other competitor countries, the Australian government failed to buy a broad portfolio of vaccines. It bet on two options — one being developed by the University of Queensland, the other by Oxford University and AstraZeneca — that could be made in Australia. This has proven a mistake.</p>
<p>It didn’t ramp up its mRNA vaccine purchasing until very late in the game. Bypassing state governments, it thought it could rely on GPs to deliver the vaccines without paying them properly or appreciating they have limited capacity, do other important things and don’t always have the specialist freezers required to store mRNA vaccines. </p>
<h2>Australia’s administrative state</h2>
<p>Australians seemed to have been surprised by the incompetence of our vaccine purchasing strategy and roll-out. With the lockdowns in Sydney, Melbourne and now Adelaide exposing the folly of Prime Minister Scott Morrison’s declaration in March that vaccination “<a href="https://thenewdaily.com.au/news/politics/2021/07/22/morrison-not-a-race-vaccine/">is not a race</a>”, his approval rating has slumped <a href="https://theconversation.com/labor-gains-clear-newspoll-lead-during-sydney-lockdown-but-will-the-economy-save-the-coalition-164557">to its lowest</a> since the pandemic began.</p>
<p>We generally trust our governments — federal, state and local — to do most things reasonably well. Indeed, compared to the rest of the world the “administrative state” in Australia works incredibly well.</p>
<p>From getting a drivers’ licence to being treated in a public hospital, enrolling a child in school or obtaining government benefits and assistance, things tend to just “work”. Kind of like an Apple product.</p>
<p>Even in wealthy countries with excellent rule of law this is not always the case. Ask anyone who has gone to the Department of Motor Vehicles in a major US city.</p>
<p>Australia’s administrative state is built on the hard work and common sense of those who work in the public sector. It has a proud track record. </p>
<p>So why has the vaccination roll-out been so botched? Was it just bad luck? Or are there broader lessons?</p>
<h2>More than just luck</h2>
<p>Well, bad luck played a role. </p>
<p>The UQ vaccine did look promising, making it to phase 1 clinical trials before it was discovered it produced results falsely suggesting recipients had HIV. It is still in “<a href="https://www.abc.net.au/news/health/2021-04-26/university-queensland-covid-19-vaccine-research-molecular-clamp/100050240">redevelopment</a>”. </p>
<p>AstraZeneca has been associated with a small risk of blood clotting, which has shaken public confidence, and led the governent’s health advisers to recommend it only for those those <a href="https://theconversation.com/astrazeneca-advice-has-just-changed-again-heres-what-you-need-to-know-if-youre-in-lockdown-163422">aged 60 or older</a>.</p>
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<a href="https://theconversation.com/how-rare-are-blood-clots-after-the-astrazeneca-vaccine-what-should-you-look-out-for-and-how-are-they-treated-161280">How rare are blood clots after the AstraZeneca vaccine? What should you look out for? And how are they treated?</a>
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<p>This is why smart investors don’t put all their eggs in one — or two — baskets. They diversify.</p>
<p>There was a lot more to our vaccine bungles than bad luck. How things turned out depended in large part on what government did. To paraphrase an <a href="https://quoteinvestigator.com/2010/07/14/luck/">old golfing saying</a>, the harder you work, the luckier you get. </p>
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Read more:
<a href="https://theconversation.com/is-the-covid-vaccine-rollout-the-greatest-public-policy-failure-in-recent-australian-history-164396">Is the COVID vaccine rollout the greatest public policy failure in recent Australian history?</a>
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<h2>Three lessons</h2>
<p>There are three lessons from the vaccination debacle.</p>
<p>First, the public service is full of great people, but the capacity of government departments has been systematically downgraded over the past few decades. </p>
<p>Both sides of politics must share some of the blame. If we as citizens are appalled by the performance of a health official, then we have to look beyond the person to the office. How did he or she end up there?</p>
<p>Second, far too much of government at a federal level is seen through a purely partisan political lens. </p>
<p>States governments, which live or die largely on the quality of service delivery, are often much better in this regard. Sure, Victorian premier Dan Andrews and his NSW counterpart Gladys Berejiklian are good politicians. But their biggest political asset is their track record in delivering for their states.</p>
<p>Third, short-termism in government thinking is a big problem. </p>
<p>Short-term thinking dulls the powerful electoral incentives that (at least partly) drive politicians to perform. As any economist will tell you, people respond to incentives. But political incentives don’t seem to be working very well these days. If voters think short-term, so will politicians. </p>
<p>We don’t necessarily need to demand more of government. We should insist political leaders act as if they care about the future — of the country, and the planet — rather than just the next election.</p>
<h2>Yes, this is a race</h2>
<p>Make no mistake: Australia’s response to the pandemic is a competition. </p>
<p>It’s a competition for international investment, skilled migrants, tourists and students. It’s a competition to provide a supportive environment for business, a well-functioning environment for consumers, and a safe environment for citizens and visitors.</p>
<p>And we’re losing. Badly. </p>
<p>Perhaps watching the Olympics over the next couple of weeks will give our leaders a patriotic shot in the arm, and inspire them to give the rest of the vaccination race their best.</p>
<p>We are counting on them.</p><img src="https://counter.theconversation.com/content/164853/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Holden is President-elect of the Academy of the Social Sciences in Australia.</span></em></p>To paraphrase a legendary golfing saying, the harder you work, the luckier you get.Richard Holden, Professor of Economics, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645502021-07-21T20:13:00Z2021-07-21T20:13:00ZWe’re paying companies millions to roll out COVID vaccines. But we’re not getting enough bang for our buck<figure><img src="https://images.theconversation.com/files/412317/original/file-20210721-23-8c5b5r.jpg?ixlib=rb-1.1.0&rect=2%2C4%2C995%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-business-people-handshaking-dark-480706102">from www.shutterstock.com</a></span></figcaption></figure><p>How we roll out vaccines is recognised as <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.02054">more important</a> to the success of vaccination programs than how well a vaccine works. And the “<a href="https://www.sciencenews.org/article/covid19-coronavirus-vaccine-last-mile-logistics-pfizer-moderna">last mile</a>” of distribution to get vaccine into people’s arms is the most difficult. </p>
<p>The Morrison government, confronted with a public service <a href="https://pmc.gov.au/sites/default/files/publications/independent-review-aps.pdf">ill-prepared for big challenges</a> and with no expertise in rolling out vaccines nationally, has contracted out many aspects of the COVID vaccine rollout to a range of for-profit companies. These include strategies and planning, vaccine distribution, delivery of vaccination programs in aged care, and systems meant to monitor these activities.</p>
<p>To date, vaccine rollout efforts have been <a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">clearly inadequate</a>. Government planning has not involved all the possible players and there was no attempt to involve the states and territories in a concerted national effort. Companies have been contracted to give overlapping advice and to provide services where that expertise already exists. </p>
<p>The lack of transparency about how some of these contracts were awarded is also an issue, along with whether the expenditure of taxpayers’ dollars is delivering value and the needed outcomes. </p>
<h2>Calling in the consultants</h2>
<p>From late 2020, the federal government engaged a raft of consultancies to provide advice on the vaccine rollout. Companies PwC and Accenture were contracted as <a href="https://www.consultancy.com.au/news/2885/pwc-and-accenture-the-lead-consultants-for-covid-19-vaccine-rollout">lead consultants</a>. </p>
<p>PwC was <a href="https://www.greghunt.com.au/contracts-signed-for-rollout-of-covid-19-vaccine/">described</a> as a “program delivery partner”. It was <a href="https://www.consultancy.com.au/news/2885/pwc-and-accenture-the-lead-consultants-for-covid-19-vaccine-rollout">engaged</a> to oversee “the operation, and coordinate activities of several actors working on specific functional areas, including — for instance — logistics partners DHL and Linfox”. In other words, PwC was contracted to oversee other contractors.</p>
<p>Accenture was engaged as the primary digital and data contractor to develop a <a href="https://www.greghunt.com.au/contracts-signed-for-rollout-of-covid-19-vaccine/">software solution</a> to track and monitor vaccine doses. This included receipt of vaccines by health services, vaccination of patients and monitoring adverse reactions. It received at least <a href="https://www.innovationaus.com/accenture-lands-7m-govt-deal-for-vaccine-data-work/">A$7.8 million</a> for this work. It is not known if any of these products were delivered or are in use.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-the-covid-vaccine-rollout-the-greatest-public-policy-failure-in-recent-australian-history-164396">Is the COVID vaccine rollout the greatest public policy failure in recent Australian history?</a>
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<p>McKinsey received a two-month contract worth <a href="https://www.theguardian.com/society/2021/apr/11/australias-covid-vaccination-relying-on-opaque-private-contracts-worth-millions">A$3 million</a> to work with the health department on vaccine issues; EY was contracted for <a href="https://www.theguardian.com/society/2021/apr/11/australias-covid-vaccination-relying-on-opaque-private-contracts-worth-millions">A$557,000</a> last November to deliver a “2020 Influenza Evaluation and Covid Vaccine System Readiness Review”. Later there was a <a href="https://www.consultancy.com.au/news/3255/department-of-health-brings-mckinsey-on-board-for-vaccine-roll-out">A$1 million</a> contract to assess vaccine system readiness and provide advice on on-shore manufacturing.</p>
<p>Despite all this “expert” — and expensive — advice, the vaccination rollout has become a shambles and is far behind schedule. So the military (Lieutenant General John Frewen) has been <a href="https://thenewdaily.com.au/news/2021/07/07/military-covid-australia/">called in</a> to take “operational control of the rollout and the messaging around the rollout”.</p>
<h2>Let’s look at distribution and logistics</h2>
<p>Last December health minister Greg Hunt <a href="https://www.greghunt.com.au/contracts-signed-for-rollout-of-covid-19-vaccine/">announced</a> the government had signed contracts with DHL and Linfox for vaccine distribution and logistics. </p>
<p>The value of the contracts remains undisclosed. However, the 2021-22 federal budget provides almost <a href="https://www.health.gov.au/sites/default/files/documents/2021/05/vaccination-program-delivery-package-covid-19-vaccine-implementation-and-rollout.pdf">A$234 million</a> for vaccine distribution, cold storage and purchase of consumables.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-has-not-learned-the-lessons-of-its-bungled-covid-vaccine-rollout-163481">Australia has not learned the lessons of its bungled COVID vaccine rollout</a>
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<p>The decision for these companies to be involved in vaccine distribution shocked many in the pharmaceutical supply industry. The government already has a well-established mechanism to supply pharmaceutical products to the most remote areas. It already does this via pharmacies and other outlets as part of the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/community-service-obligation-funding-pool">community service obligation</a> funded under the <a href="https://theconversation.com/explainer-what-is-the-community-pharmacy-agreement-38789">Community Pharmacy Agreement</a>. </p>
<p>This supply network, for which the government pays <a href="https://www.ahaconsulting.com.au/resources/community-service-obligation-funding-pool/">A$200 million per year</a>, involves a small number of pharmaceutical wholesalers with decades of experience in delivering to pharmacies. In remote areas, the network also delivers to medical services and doctors’ offices. It’s the same network used every year to deliver flu vaccines. </p>
<p>Pharmaceutical wholesalers <a href="https://www.smh.com.au/business/companies/pharmacy-operators-pitch-expertise-for-covid-19-vaccine-plan-20200914-p55vhk.html">offered</a> their expertise. But the government did not approach them to undertake this work. The federal government also ignored the capabilities of state hospital systems, which routinely deliver time-sensitive items such as radioisotopes and blood products.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/vaccines-are-here-but-how-will-we-get-them-to-billions-of-people-151132">Vaccines are here, but how will we get them to billions of people?</a>
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<h2>More contracts, this time for vaccination programs</h2>
<p>The federal government took on responsibility for vaccinating people in aged and disability care, and GP respiratory clinics. It has contracts totalling <a href="https://www.crikey.com.au/2021/05/17/private-contractors-covid-vaccination-secrecy/">A$155.9 million</a> with Aspen Medical, Healthcare Australia, Sonic Healthcare and International SOS to deliver these services.</p>
<p>Despite the fact these companies were selected in <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/mobilising-australias-covid-19-vaccine-workforce">January</a>, planning has been abysmal. </p>
<p>Only now have <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/press-conference-in-melbourne-on-5-july-2021-about-a-mandated-vaccination-for-aged-care-workers-the-vaccine-rollout-and-a-covid-19-update">most residents</a> in aged care facilities been fully vaccinated. Meanwhile many workers in these facilities and people receiving and delivering care in the community are <a href="https://www.theage.com.au/politics/victoria/company-giving-aged-care-vaccines-never-contracted-to-immunise-workers-20210601-p57x4x.html">yet to receive a jab</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1417356103340355592"}"></div></p>
<p>The health department has not made these contracts public, <a href="https://www.smh.com.au/politics/federal/big-liberal-donor-among-health-firms-selected-to-run-vaccine-rollout-20210427-p57my4.html">citing</a> “commercial-in-confidence” issues. There has been <a href="https://www.smh.com.au/politics/federal/big-liberal-donor-among-health-firms-selected-to-run-vaccine-rollout-20210427-p57my4.html">confusion</a> about what the contracts covered and concern the firms involved are <a href="https://www.crikey.com.au/2021/05/17/private-contractors-covid-vaccination-secrecy/">significant</a> <a href="https://eminetra.com.au/contractors-get-156m-to-vaccinate-the-most-at-risk-why-the-secrecy/166907/">Liberal Party donors</a>.</p>
<p>There have been widespread logistical problems with juggling vaccine deliveries, having the workforce available to do vaccinations, and demand. Poor planning has led to <a href="https://www.theguardian.com/australia-news/2021/feb/26/australias-covid-vaccine-rollout-errors-cancellations-and-missed-deadlines">cancelled vaccinations</a> in aged care and thousands of doses <a href="https://www.abc.net.au/news/2021-04-01/claims-covid-vaccines-thrown-away-at-toowoomba-carbal-clinic/100043382">thrown away</a> in one clinic after problems with temperature-controlled storage.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-government-is-spending-almost-a-24m-to-convince-us-to-accept-a-covid-vaccine-but-will-its-new-campaign-actually-work-154062">The government is spending almost A$24m to convince us to accept a COVID vaccine. But will its new campaign actually work?</a>
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<h2>Where to next?</h2>
<p>The key task now is to get all Australians vaccinated. </p>
<p>This will require a competent, reliable and integrated system operating at full efficiency. Those aspects of the system that are the responsibility of the federal government (or its contractors) must be better coordinated with the efforts of the states and territories, GPs and others involved in the vaccination rollout. That should be a key responsibility of Lieutenant General Frewen.</p>
<p>The effort to get more Australians vaccinated requires the public having trust in the system that will get us there and the communications that accompany that.</p>
<p>We have no way of knowing what advice the government has received and indeed, whether that advice was implemented. For-profit companies have been contracted to perform vital services, but we do not know at what cost to taxpayers and whether key performance indicators are being met — or even if they exist.</p>
<p>Openness and transparency are the pillars on which trust in government is built. Currently they are sadly lacking.</p><img src="https://counter.theconversation.com/content/164550/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Expensive, opaque and in duplicate. Why company contracts to help the COVID vaccine rollout are such a concern.Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1637332021-07-02T00:01:57Z2021-07-02T00:01:57ZHow can younger Australians decide about the AstraZeneca vaccine? A GP explains<figure><img src="https://images.theconversation.com/files/409390/original/file-20210701-19-10959af.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-consultant-meeting-teenage-patient-284516786">Shutterstock</a></span></figcaption></figure><p>It has been a wild week for public messaging about the AstraZeneca COVID-19 vaccine — baffling both for the public and for general practitioners like me. </p>
<p>Just over two weeks ago, <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">the Australian Technical Advisory Group on Immunisation</a> (ATAGI) advised the AstraZeneca vaccine was now preferred only for people over 60. The Pfizer vaccine was encouraged in those under 60, but this isn’t yet widely available.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-under-60-will-no-longer-receive-the-astrazeneca-vaccine-so-whats-changed-162930">Australians under 60 will no longer receive the AstraZeneca vaccine. So what's changed?</a>
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<p>Prime Minister Scott Morrison sparked a controversy on Monday, <a href="https://www.pm.gov.au/media/virtual-press-conference-1">saying</a> ATAGI’s advice did not prohibit the vaccine in younger people. He invited people under 60 to chat to their GPs about it. This was reported as a “<a href="https://www.abc.net.au/news/2021-06-29/coronavirus-vaccine-under-40s-can-request-astrazeneca/100251000">massive change</a>” to the vaccine program.</p>
<p>His comments were rebuked by <a href="https://www.abc.net.au/news/2021-06-30/qld-cho-rejects-morrisons-astrazeneca-comments-covid-vaccine/100256022">health officers</a> and <a href="https://theconversation.com/view-from-the-hill-scott-morrisons-astrazeneca-hand-grenade-turns-into-cluster-bomb-163680">premiers</a>. </p>
<p>Meanwhile, Health Minister Greg Hunt <a href="https://www.theguardian.com/australia-news/2021/jun/30/rift-between-states-and-morrison-government-over-astrazeneca-vaccine-for-under-40s-grows">explained</a> there had been “no change” to the medical advice.</p>
<p>For many, these disagreements were <a href="https://www.sbs.com.au/news/amid-australia-s-confusing-advice-on-astrazeneca-this-is-how-other-countries-are-using-it">confusing</a>.</p>
<p>Hunt is right, though: the <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">ATAGI advice</a> has remained the same since mid-June. The advice is careful and nuanced:</p>
<blockquote>
<p>COVID-19 Vaccine AstraZeneca can be used in adults aged under 60 years for whom Comirnaty [Pfizer] is not available, 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.</p>
</blockquote>
<p>Let’s dig into this sentence’s subtleties, and try to shed light rather than heat on the issue.</p>
<h2>Three principles for decision-making</h2>
<p>ATAGI’s sentence above contains three principles, all of which should be true if the AstraZeneca vaccine is to be used in a person under 60.</p>
<p><strong>First</strong>, the Pfizer vaccine should be unavailable. This is the case for many people at the moment. Anecdotally, I’m told of waits of about three months for the Pfizer, if you can get an appointment at all. A surge in availability is <a href="https://www.smh.com.au/politics/federal/two-million-pfizer-doses-a-week-from-october-enough-for-everyone-by-christmas-20210521-p57u25.html">promised</a>, but not until October.</p>
<p><strong>Second</strong>, the benefits of the AstraZeneca vaccine should outweigh the risks. This is tough, as risks and benefits can be hard to estimate.</p>
<p>The major (and well-known) risk of the AstraZeneca vaccine is <a href="https://theconversation.com/how-rare-are-blood-clots-after-the-astrazeneca-vaccine-what-should-you-look-out-for-and-how-are-they-treated-161280">an unusual clotting syndrome</a>, which is <a href="https://mvec.mcri.edu.au/references/thrombosis-with-thrombocytopenia-syndrome/">rare, treatable, but sometimes fatal</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-rare-are-blood-clots-after-the-astrazeneca-vaccine-what-should-you-look-out-for-and-how-are-they-treated-161280">How rare are blood clots after the AstraZeneca vaccine? What should you look out for? And how are they treated?</a>
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<p>The benefits include <a href="https://pubmed.ncbi.nlm.nih.gov/33306989/">prevention of COVID</a> and <a href="https://www.bmj.com/content/bmj/373/bmj.n1088.full.pdf">its consequences</a>, including hospitalisation and death.</p>
<p>The balance between risks and benefits depends on the person’s risk of being exposed to COVID (which might vary based on travel or occupation) and on their risk of bad outcomes (like death) should they get COVID. </p>
<p>Age seems the most important risk factor for these terrible outcomes, but <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05992-1">other conditions appear important</a> too, including heart disease, lung disease, high blood pressure, diabetes and cancer. (Though people under 60 with these conditions are eligible for Pfizer, at present they may be kept waiting.)</p>
<p>The risk of virus exposure depends greatly on how much COVID is present in our community. The less there is about, the less likely you’ll catch it. But this can change quickly and unpredictably, adding difficulty to decisions.</p>
<p><strong>Third</strong>, the person receiving the vaccine needs to give their informed consent based on an understanding of these risks and benefits.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409395/original/file-20210701-19-mteltv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">To give informed consent, you need to understand the risks and benefits.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/IFKv3LESkVg">CDC/Unsplash</a></span>
</figcaption>
</figure>
<h2>Informed consent</h2>
<p><a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_1.pdf">Handy decision aids</a> help visualise some, but not all, of these risks. For example, this figure shows the trade-off between risks and benefits during a relatively mild outbreak, equivalent to Australia’s first COVID wave.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=533&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=533&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=533&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=670&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=670&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409391/original/file-20210701-15-t6v8c0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=670&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_1.pdf">Screenshot from health.gov.au</a></span>
</figcaption>
</figure>
<p>In this setting, the benefits of vaccination don’t clearly outweigh the risks until people are over the age of 60. This is why ATAGI has used 60 as an age threshold for using the AstraZeneca vaccine.</p>
<p>But if we had a severe outbreak, like in Europe last winter, the benefits of the vaccine would easily outweigh the risks, even in people from the age of 30.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=246&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=246&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=246&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=309&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=309&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409393/original/file-20210701-13-1pv4f60.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=309&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_1.pdf">Screenshot from health.gov.au</a></span>
</figcaption>
</figure>
<h2>Individual decisions</h2>
<p>These charts are helpful for thinking about how age and disease prevalence affect decisions. But they don’t include all relevant facts. For this, a discussion with a GP could be helpful — ideally a GP who knows you well.</p>
<p>ATAGI’s co-chair Christopher Blyth has recently clarified the AstraZeneca vaccine should only be used under 60 <a href="https://www.sbs.com.au/news/this-is-what-australia-s-top-vaccine-advice-body-says-about-astrazeneca-and-under-40s">in “pressing” circumstances</a>. </p>
<p>I can imagine such circumstances. For example, consider a 59 year-old with diabetes and heart disease who plans to travel to a country with many COVID cases. Here, I’d feel confident the benefits outweigh the risks. </p>
<p>However, imagine a 25 year-old with no underlying medical conditions, not travelling, and not working in a high-risk profession. Compared to the previous example, risks are similar, but benefits are fewer. It’d be hard to convince myself the benefits would outweigh the harms here — at least not while our COVID case numbers remain low.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/under-40s-can-ask-their-gp-for-an-astrazeneca-shot-whats-changed-what-are-the-risks-are-there-benefits-163571">Under-40s can ask their GP for an AstraZeneca shot. What's changed? What are the risks? Are there benefits?</a>
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<hr>
<p>However, our case numbers are unlikely to stay low forever and if we wait for a big outbreak before vaccinating, immunity may arrive too late.</p>
<p>These are fraught decisions, full of ethical tensions. I want to respect my patient’s autonomy — and there’s a part of me that feels I should be able to vaccinate anyone if they are informed and want the vaccine. After all, many people take other, <a href="https://theconversation.com/concerned-about-the-latest-astrazeneca-news-these-3-graphics-help-you-make-sense-of-the-risk-162175">bigger risks</a> elsewhere in their life.</p>
<p>And it’s admirable many younger Australians seeking vaccination are doing so not just for themselves but also to protect their community. But balanced with this, we need to try to minimise harm.</p>
<figure class="align-center ">
<img alt="A gloved hand holds an AstraZeneca vial." src="https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409396/original/file-20210701-19-1gsn6fr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The risks are small but real, and need to be balanced with the benefits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/darmstadt-germany-2702-astrazeneca-covid19-vaccine-1926164738">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Under 60 and still keen for a vaccine?</h2>
<p>If you want to be vaccinated and are under 60, and Pfizer is unavailable, you could speak to your GP — especially if your circumstances put you at special risk. </p>
<p>I think it is best to do this in a special consultation rather than squeezing it into an immunisation clinic time slot. Because our vaccines come in multidose vials, most practices run quite rapid-fire vaccination clinics, allowing only a few minutes for each person. Such clinics are workable for uncontroversial vaccine decisions in people over 60, but mightn’t allow enough time for complex decisions with younger people.</p>
<p>By working with your GP, I hope you’ll feel you can arrive at the decision best suited to your circumstances and values.</p><img src="https://counter.theconversation.com/content/163733/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brett Montgomery works as a general practitioner, mostly academically but also clinically. In his clinical role he, like many Australian GPs, discusses and provides COVID-19 vaccination as part of his paid work. At present the practice he works at offers the AstraZeneca vaccine, but not the Pfizer vaccine. He has personally had two doses of the AstraZeneca vaccine, despite being under the age of 50; he had his first dose before the link to a clotting disorder was apparent. He is affiliated with several organisations with health policy interests, including the Royal Australian College of General Practitioners, the Doctors Reform Society and the Australian Greens. However, he writes this article in a personal capacity. </span></em></p>The messages people under 60 have been getting about the AstraZeneca vaccine this week have been confusing, to say the least. Experts say to consider the risks and benefits. But how do you do this?Brett Montgomery, Senior Lecturer in General Practice, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1634792021-06-30T19:59:56Z2021-06-30T19:59:56ZVaccine Rollout 2.0: Australia needs to do 3 things differently<figure><img src="https://images.theconversation.com/files/409049/original/file-20210630-23-1crdcj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/fVz1FH7sHx4">Unsplash/CDC</a></span></figcaption></figure><p>Australia’s vaccine rollout started just over four months ago. It has not gone well, to put it mildly. To date, only <a href="https://ourworldindata.org/covid-vaccinations">24% of the population</a> have had at least one dose of a vaccine, and nearly 5% – 1.2 million people – have been fully vaccinated.</p>
<p>This rate is far too slow. The United Kingdom and the United States are showing that effective mass vaccination programs can work, with <a href="https://www.bbc.com/news/health-55274833">more than 80% of Brits</a> and <a href="https://www.mayoclinic.org/coronavirus-covid-19/vaccine-tracker">54% of Americans</a> having received their first dose. Australia should be just as ambitious.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409718358505791516"}"></div></p>
<p>The federal government should press the reset button and shift to Rollout 2.0.</p>
<p>Rollout 1.0 was plagued with supply problems – there just wasn’t enough of either vaccine available. But from July, there will be <a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-covid-vaccination-allocations-horizons.pdf">more supply</a>, with about two million Pfizer doses, and half a million Moderna doses available per week from October – more than enough to cover the whole adult population.</p>
<p>With supply looking sorted, the federal government should set a new goal for when all adults will be able to receive full vaccination by.</p>
<p>The government – and its army of rollout consultants – has had months to learn from its mistakes. The actual army has also been called in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/calling-in-the-army-for-the-vaccine-rollout-and-every-other-emergency-shows-how-ill-prepared-we-are-162247">Calling in the army for the vaccine rollout and every other emergency shows how ill-prepared we are</a>
</strong>
</em>
</p>
<hr>
<p>The government has no excuse not to have all arrangements in place for an efficient vaccination program when the vaccines begin rolling in.</p>
<p>Three key things need to be done differently to achieve this goal.</p>
<h2>1. Fix the logistics</h2>
<p>The supply side of Rollout 1.0 was a shemozzle. GPs and state governments had no idea how many doses were going to arrive and when. This was partly due to slow supply of doses from overseas, but mainly due to slow supply from the local producer, CSL.</p>
<p></p>
<p>That should not be a worry under Rollout 2.0.</p>
<p>But Rollout 1.0 was also a distribution nightmare. It was seemingly impossible for anyone to organise to get doses from place A to place B.</p>
<p>There are now fewer anecdotes about distribution disasters than a few months ago, but the government needs to assure the public that the supply chain and distribution networks are working efficiently.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-pfizer-covid-vaccine-gets-from-the-freezer-into-your-arm-155453">How the Pfizer COVID vaccine gets from the freezer into your arm</a>
</strong>
</em>
</p>
<hr>
<p>If I can be notified when my book or beer is due to arrive – and even the driver’s name – then GPs and state vaccine hubs should be able to be notified when their doses are due to arrive.</p>
<p>And it should be as easy for me to book my vaccination online as it is to book a restaurant table or parcel pick-up online, with advance bookings helping to guide where extra doses should be allocated.</p>
<h2>2. Widen the channels</h2>
<p>Of the Australians who are getting vaccinated, <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-cumulative-doses-administered-by-channel">just over half</a> are doing so through GPs and primary care clinics.</p>
<p>If Rollout 2.0 is to make use of the millions of new doses arriving every week, it will need to deliver at least three times as many doses every week as it has been able to achieve so far.</p>
<p>Government planning seems to be putting GPs front and centre of Rollout 2.0 – the same strategy that failed in Rollout 1.0.</p>
<p>Sure, GPs should be invited to step up, but governments should continue to put a focus on mass state-run vaccination hubs that <a href="https://www.medrxiv.org/content/10.1101/2021.04.07.21255067v1">can vaccinate</a> up to 1,400 people every eight hours, compared to GP clinics that can vaccinate only 100 to 300 people in the same time.</p>
<p>Rollout 2.0 needs to increase both the hours existing outlets are available and expand the number of large vaccination hubs. It should also introduce new outlets such as pharmacies.</p>
<p>States should bring vaccines to people, by providing on-site pop-up vaccination centres at major sports events, workplace hubs, universities, major public transport stations, housing commissions, and regional town centres.</p>
<p>When the Pfizer vaccine is approved for people under 16, states should also arrange for vaccinations to be done in schools.</p>
<p>Because more doses will be available within one month, <a href="https://www.theage.com.au/politics/victoria/top-up-pfizer-would-be-used-to-fully-vaccinate-victorians-state-government-told-commonwealth-20210616-p581jl.html">states should no longer stockpile doses</a> to ensure second-dose availability but rely on fewer supplies for this purpose.</p>
<p>A faster rollout will need a bigger workforce. Planning needs to start now on how we should draw on medical, nursing, and pharmacy students to contribute to Rollout 2.0.</p>
<h2>3. Tackle vaccine hesitancy</h2>
<p>As the government fixes the supply side, it also needs to tackle the demand side – vaccine hesitancy. About <a href="https://www.smh.com.au/politics/federal/vaccine-concerns-ease-but-only-slightly-as-26-per-cent-say-unlikely-to-get-jab-20210615-p5812s.html">25% of Australian adults</a> say they may not get the jab. The aim should be to change the minds of those who are unsure, rather than focusing on those who are much less willing.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=806&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=806&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=806&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1013&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1013&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409057/original/file-20210630-19-o39f6k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1013&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>There is <a href="https://www.sciencedirect.com/science/article/pii/S1364661321000334">a science</a> behind what works in addressing COVID vaccine hesitancy, drawing on <a href="https://www.tandfonline.com/doi/citedby/10.1080/21645515.2017.1394533">previous vaccine campaigns</a>. Government should use it, rather than developing ads that look like the cheapest possible <a href="https://www.smh.com.au/culture/tv-and-radio/australia-s-vaccination-ad-is-literally-wallpaper-how-can-it-be-fixed-20210521-p57u0g.html">bland offering</a>, which <a href="https://www.crikey.com.au/2021/06/25/where-bloody-hell-covid-19-ads/">compare poorly to international offerings</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1405278767627399168"}"></div></p>
<p>There is not one slick answer, and no one campaign. Different demographics will respond to different messaging. Different reasons for hesitancy will need to be addressed differently.</p>
<p>Ads should be placed at <a href="https://www.abc.net.au/news/2021-06-19/australia-covid-vaccine-ads-strategy-improvement/100227610">times when target audiences might be watching TV</a>.</p>
<p>A text message campaign could be used, sent to all Australian adults, regardless of their vaccination status, encouraging them to get vaccinated and telling them how, <a href="https://www.england.nhs.uk/2021/03/nhs-text-alerts-for-life-saving-covid-jab/">as is done in the UK</a>.</p>
<p>Some campaigns could start now, promoting the benefits of vaccines to individuals and their efficacy. Messaging should also emphasise the collective benefits of high vaccination rates, including protecting the vulnerable and bringing stranded Australians home, just as our collective effort saved lives to date.</p>
<p>Better real-time tracking of vaccine uptake by demographics can be used to develop different messages for different audiences.</p>
<p>The campaigns should <a href="https://www.nature.com/articles/s41591-020-1124-9#Tab2">go beyond simply pronouncing</a> that all the vaccines are safe and effective. The communication should be ongoing, clear and actionable, address concerns, and de-bunk misunderstandings, <a href="https://www.mja.com.au/journal/2021/communicating-patients-and-public-about-covid-19-vaccine-safety-recommendations">without over-reassuring</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-government-is-spending-almost-a-24m-to-convince-us-to-accept-a-covid-vaccine-but-will-its-new-campaign-actually-work-154062">The government is spending almost A$24m to convince us to accept a COVID vaccine. But will its new campaign actually work?</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.smh.com.au/politics/federal/older-australians-especially-older-women-most-concerned-about-covid-vaccines-20210519-p57tc4.html">Younger people, women</a>, and people who live beyond the inner-city are more likely to be hesitant. Communications should <a href="https://www.anu.edu.au/files/guidance/COVID%252019%2520in%2520Australia,%2520What%2520factors%2520drive%2520pro-vaccination%2520behaviour.pdf">build trust and confidence</a> in government, and not pit groups against each other, which would only increase hesitancy.</p>
<p>The government has over-promised and under-delivered on Rollout 1.0. It needs to push the reset button so that Rollout 2.0 takes Australians to a vaccine-protected future as soon as possible.</p><img src="https://counter.theconversation.com/content/163479/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website. Stephen Duckett has been partially vaccinated with AstraZeneca.</span></em></p><p class="fine-print"><em><span>Anika Stobart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With enough vaccine supplies coming online from October, the government has no excuse not to have all arrangements in place for an efficient vaccination program. Here’s what needs to change.Stephen Duckett, Director, Health Program, Grattan InstituteAnika Stobart, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1635712021-06-29T11:48:04Z2021-06-29T11:48:04ZUnder-40s can ask their GP for an AstraZeneca shot. What’s changed? What are the risks? Are there benefits?<figure><img src="https://images.theconversation.com/files/408785/original/file-20210629-14-m3qjz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/serious-frowning-indian-ethnicity-woman-sit-1835827408">Shutterstock</a></span></figcaption></figure><p>Pfizer remains the “preferred” vaccine for Australians aged under 40, due to a small but real increased risk of a rare clotting disorder. </p>
<p>But last night <a href="https://www.pm.gov.au/media/virtual-press-conference-1">Prime Minister Scott Morrison said</a> younger Australians who didn’t want to wait could ask their GP for an AstraZeneca vaccine instead. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409531446331469827"}"></div></p>
<p>So far <a href="https://covidlive.com.au/report/vaccinations-people">29% of Australians</a> have received a first dose of a COVID-19 vaccine, and 7% have had their second. </p>
<p>While Australia has low numbers of COVID-19 cases overall, outbreaks and lockdowns are causing significant disruption in our lives, prompting some younger people to seek out a vaccine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-shouldnt-blame-young-people-for-jumping-the-queue-to-get-a-covid-vaccine-they-could-be-doing-us-a-favour-162927">We shouldn't blame young people for 'jumping the queue' to get a COVID vaccine. They could be doing us a favour</a>
</strong>
</em>
</p>
<hr>
<p>In most states, people under 40 may have not yet been vaccinated if they’re not in a priority or high-risk group, as the national rollout is yet to offer Pfizer to under-40s.</p>
<p>But this statement from the prime minister opens up access to an AstraZeneca vaccine for anyone under 40 years. </p>
<p>The prime minister also announced an indemnity scheme to cover GPs who give the AstraZeneca vaccine to someone who has a severe adverse reaction. But the finer details of this new scheme, and what it covers, are not yet available.</p>
<h2>Astra wasn’t ‘banned’ for young people, just not ‘preferred’</h2>
<p>The Australian Technical Advisory Group on Immunisation (ATAGI), a group of vaccine experts which advises the government, <a href="https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns">recommended</a> on April 8 that Pfizer be the “preferred” vaccine for adults aged under 50.</p>
<p>This recommendation was based on a risk-benefit assessment at the time. The increased risk of the rare but serious clotting event following AstraZeneca vaccine in those under 50 years outweighed the potential benefit, given how much COVID-19 was circulating at the time. </p>
<p>However ATAGI said AstraZeneca could still be used in adults aged under 50 years where:</p>
<blockquote>
<p>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. </p>
</blockquote>
<p>ATAGI then updated its advice on <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">June 17</a> to say Pfizer was the preferred vaccine for those under 60 years. </p>
<p>This increase in age recommendation was because <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">new data identified a higher risk</a> of clotting after AstraZeneca among 50- to 59-year-old Australians than had been reported internationally and initially estimated in Australia. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1405473261001994241"}"></div></p>
<p>ATAGI reiterated on June 17 that AstraZeneca could be used in adults under 60 for whom Pfizer wasn’t available, where the benefits outweighed the risks for the person, and they made an informed decision.</p>
<h2>What about now?</h2>
<p>Last night the Prime Minister <a href="https://www.abc.net.au/news/2021-06-29/covid-astrazeneca-vaccine-australia-new-no-fault-indemnity-gps/100251376">said</a>:</p>
<blockquote>
<p>if you wish to get the AstraZeneca vaccine, then we would encourage you to go and have that discussion with your GP. </p>
</blockquote>
<p>Professor Paul Kelly, Australia’s Chief Health officer <a href="https://www.health.gov.au/news/chief-medical-officer-professor-paul-kellys-interview-on-abc-news-breakfast-on-29-june-2021">later clarified</a>:</p>
<blockquote>
<p>there’s a preference for Pfizer up to the age of 60. But that preference is a preference. It’s a discussion for doctors to have with their own patients and work through their own risk and benefit in relation to that. </p>
</blockquote>
<h2>What should you weigh up?</h2>
<p>Resources such as <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca">this decision guide</a> can help you weigh up the potential benefits and harms for your circumstances, to make an informed decision about the AstraZeneca vaccine. </p>
<p>So, what are the side effects and more serious adverse effects?</p>
<p>The common side effects of AstraZeneca vaccination include fatigue, headache, body aches and fever and, rarely, anaphylaxis. These are most often after dose one and happen in the first two to three days after vaccination. </p>
<p>We know this because Australia’s active safety surveillance system, <a href="https://ausvaxsafety.org.au/safety-data/covid-19-vaccines">AusVaxSafety</a>, has captured vaccine reactions in over one million surveys, including more than 350,000 people who have had a first dose of AstraZeneca. </p>
<figure class="align-center ">
<img alt="Health worker putting a bandaid on a person's arm after vaccination." src="https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408864/original/file-20210629-24-cdn183.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We have a good idea of the side effects and adverse effects from the AstraZeneca vaccine.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/90ejoVTj2-M">CDC/Unsplash</a></span>
</figcaption>
</figure>
<p>The clotting condition which causes most concern is called thrombosis with thrombocytopenia syndrome, or TTS. This involves blood clots (thrombosis), often in places we don’t usually see clots, such as the brain and abdomen. </p>
<p>It also causes low levels of blood clotting cells called platelets (thrombocytopenia). </p>
<p>We still don’t know the exact mechanism of TTS, but it appears to be caused by an overactive immune response, which is very different from other clotting disorders.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-rare-are-blood-clots-after-the-astrazeneca-vaccine-what-should-you-look-out-for-and-how-are-they-treated-161280">How rare are blood clots after the AstraZeneca vaccine? What should you look out for? And how are they treated?</a>
</strong>
</em>
</p>
<hr>
<p>The <a href="https://www.health.gov.au/sites/default/files/documents/2021/06/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_1.pdf">estimates</a> of clotting risk associated with first doses of the AstraZeneca vaccine are listed in the chart below. New cases detected are <a href="https://www.tga.gov.au/covid-19-vaccine-safety-monitoring-and-reporting">updated weekly</a> on the Therapeutic Goods Administration (TGA) website.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408863/original/file-20210629-26-hpt607.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">The Conversation/ATAGI</a></span>
</figcaption>
</figure>
<p>(Keep in mind, the <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca">risk estimates</a> in the under-50s are based on a much smaller number of people who received the AstraZeneca vaccine compared to those over 50.) </p>
<p>The severity of illness due to TTS ranges from fatal cases and severe disease, which is more likely to occur in younger people, to relatively milder cases. In Australia, the <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca">overall chance of dying</a> from TTS is 3-4%. </p>
<p>It’s not currently possible to predict who will develop TTS. The only risk factor for TTS identified right now is age – it’s much less likely to occur in older adults than younger people.</p>
<p>TTS appears to be far more rare following second doses, with data from the United Kingdom indicating a rate of <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-17-06-2021#section-518">1.5 per million</a> second doses. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-my-second-astrazeneca-dose-yes-it-almost-doubles-your-protection-against-delta-163259">Should I get my second AstraZeneca dose? Yes, it almost doubles your protection against Delta</a>
</strong>
</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>So, if you are under 40 years old and want to get a COVID-19 vaccine the options are:</p>
<ol>
<li><p>wait until Pfizer becomes available for your specific situation (you can use the <a href="https://covid-vaccine.healthdirect.gov.au/eligibility">vaccine eligibility checker</a> to see when you’re eligible)</p></li>
<li><p>think about getting an AstraZeneca vaccine. </p></li>
</ol>
<p>The best advice is to discuss with your GP your own unique story, and the risks and benefits as they relate to you.</p><img src="https://counter.theconversation.com/content/163571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding for a Career Development Fellowship from the NHMRC. He holds a Churchill Fellowship.</span></em></p>While Pfizer is still the preferred vaccine for under 40s, those who don’t want to wait can now talk to their GP about getting an AstraZeneca shot. But what risks and benefits do you need to weigh up?Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1629272021-06-22T20:04:08Z2021-06-22T20:04:08ZWe shouldn’t blame young people for ‘jumping the queue’ to get a COVID vaccine. They could be doing us a favour<p>Over recent weeks, we’ve seen reports <a href="https://www.sbs.com.au/news/it-allowed-me-to-book-people-under-40-are-getting-their-covid-19-vaccines-early-in-nsw">some Australians under 40</a> who are not yet eligible for a COVID-19 vaccine have been getting their first dose.</p>
<p>These are people who don’t fall into a priority group outlined <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">by the federal government</a>, and are not eligible under the current rules in their state or territory. </p>
<p>These young people have been described as “<a href="https://www.theguardian.com/australia-news/2021/jun/16/queue-jumping-australians-under-40-receiving-covid-vaccine-despite-not-being-eligible">queue jumping</a>”. Although some might be jumping the queue, most, in my view, are not doing anything wrong. </p>
<p>Besides, given how slowly the <a href="https://www.theguardian.com/australia-news/ng-interactive/2021/jun/21/covid-19-vaccine-rollout-australia-coronavirus-vaccination-progress-updates-tracker-victoria-nsw-queensland-qld-daily-live-data-stats-updates-total-numbers-distribution-schedule-tracking-new-cases-today">vaccine rollout</a> is progressing in Australia, these eager young folks may actually be doing us all a favour.</p>
<h2>What exactly is going on?</h2>
<p>It appears some younger ineligible Australians are getting the Pfizer vaccine, while others are choosing to take the AstraZenca vaccine. </p>
<p>The Australian Technical Advisory Group on Immunisation (ATAGI) has advised <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">people under 60</a> (previously people under 50) should not be given the AstraZenca vaccine because of the risk of thrombosis with thrombocytopenia syndrome (TTS), a rare but serious blood clotting disorder. </p>
<p>Some younger Australians are <a href="https://www.theguardian.com/australia-news/2021/jun/16/queue-jumping-australians-under-40-receiving-covid-vaccine-despite-not-being-eligible">accepting this risk</a> in order to get the AstraZeneca vaccine before they’re eligible for Pfizer. </p>
<p>But how are young Australians who are not technically eligible getting either vaccine in the first place? Reports suggest there are three ways: </p>
<ul>
<li><p>they’re <a href="https://www.theguardian.com/australia-news/2021/jun/16/queue-jumping-australians-under-40-receiving-covid-vaccine-despite-not-being-eligible">showing up</a> at the vaccination sites and seeing if they can get a vaccine at the discretion of health-care staff, presumably if there’s no one else scheduled at that time</p></li>
<li><p>they’re <a href="https://www.theguardian.com/australia-news/2021/jun/16/queue-jumping-australians-under-40-receiving-covid-vaccine-despite-not-being-eligible">registering online</a> through the regular channels. They’re providing their information truthfully and the system is allowing them to book in </p></li>
<li><p>they’re using <a href="https://www.theguardian.com/australia-news/2021/jun/10/boomers-had-their-chance-under-40s-getting-pfizer-vaccine-in-nsw-despite-not-being-eligible">online links</a> that were intended for people who are actually eligible (for example, household contacts of health-care workers).</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-if-olympians-are-jumping-the-covid-vaccine-queue-thats-not-necessarily-wrong-a-bioethicist-explains-159907">Even if Olympians are jumping the COVID vaccine queue, that's not necessarily wrong. A bioethicist explains</a>
</strong>
</em>
</p>
<hr>
<p>It’s important to note the context here. Some evidence suggests there’s a higher level of <a href="https://www.smh.com.au/politics/federal/almost-one-third-of-adult-australians-say-they-re-unlikely-to-get-covid-vaccination-survey-20210518-p57szo.html">vaccine hesitancy</a> than predicted or desired among Australians (around one-third of all adults). </p>
<p>The rollout of the vaccine in Australia has been slow and troubled for a variety of reasons, including changing safety advice and <a href="https://www.theguardian.com/australia-news/2021/jun/21/australias-vaccine-rollout-constrained-by-pfizer-supply-shortages-until-august">logistical issues</a>.</p>
<p>Mixed messaging from politicians doesn’t help. For example, claims the vaccination rollout is “<a href="https://www.theguardian.com/australia-news/2021/jun/01/the-morrison-governments-vaccine-rollout-is-not-a-race-nonsense-tells-us-a-lot-about-whats-gone-wrong">not a race</a>” are off the mark. Speed is in fact of the essence.</p>
<figure class="align-center ">
<img alt="A young woman wearing a mask with a bandaid on her upper arm." src="https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=355&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=355&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=355&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=447&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=447&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407585/original/file-20210622-26-bbi83z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=447&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young Australians managing to get in early for their COVID jab are either just showing up, or booking online.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Most younger Australians are not queue jumping</h2>
<p>From an ethical standpoint, what matters is making sure you don’t potentially disadvantage or harm other people who are in greater need of the vaccine than you are. </p>
<p>Generally speaking, if <a href="https://www.bmj.com/content/321/7272/1300">there are good reasons provided</a> for the order in which a scarce resource will be allocated, no individual person should cheat their fellow resident from that resource by disregarding the allocation process.</p>
<p>While Australia’s priority list is morally defensible, I would argue there’s little “queue jumping” occurring. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">4 ways Australia's COVID vaccine rollout has been bungled</a>
</strong>
</em>
</p>
<hr>
<p>First, those younger Australians choosing to take the AstraZenca vaccine are not taking away a scarce resource. There is plenty of <a href="https://www.theguardian.com/australia-news/2021/may/19/more-than-15m-covid-vaccines-sitting-unused-in-clinics-across-australia">the AstraZenca vaccine</a>, although the Pfizer vaccine is in much shorter supply. </p>
<p>There may be an ethical question about whether younger people should be offered the AstraZenca vaccine at all given the risk of TTS and ATAGI’s recommendations. But assuming people are giving their free and informed consent, we can set aside this concern for now. </p>
<p>Those younger ineligible Australians who are taking the Pfizer vaccine may be said to be jumping the queue. But if they’re telling the truth when enrolling online, or perhaps waiting until the end of the day to use a dose <a href="https://www.abc.net.au/news/2021-04-03/vaccination-wastage/100040666">that would otherwise go to waste</a> — and a health-care worker at a vaccination centre is giving them permission to be vaccinated — they can’t be accused of queue jumping. </p>
<p>The rules around allocation, and the enforcement of those rules, cannot rest with each individual, but rather lies with those in charge of delivering vaccines. If there are spare vaccine doses to be had, this suggests there’s a system failure at some point between vaccine procurement and delivery.</p>
<p>The only people who could be rightfully accused of queue jumping are those who register for vaccines with links that aren’t meant for them. Doing so is a clear intent to bypass the rules and enforcement mechanisms in place.</p>
<h2>We want vaccines in arms</h2>
<p>Unless people who are eligible and want to receive the Pfizer vaccine are being denied access — and I haven’t heard this is happening, at least not because of queue jumping — then the default should be to vaccinate as many Australians as possible, as quickly as possible. </p>
<p>We know individuals won’t be as safe as they could be until a large proportion of the population is vaccinated. We also know our vaccine rollout <a href="https://www.theguardian.com/australia-news/ng-interactive/2021/jun/21/covid-19-vaccine-rollout-australia-coronavirus-vaccination-progress-updates-tracker-victoria-nsw-queensland-qld-daily-live-data-stats-updates-total-numbers-distribution-schedule-tracking-new-cases-today">is well behind</a> schedule.</p>
<p>So if anything, we should be thanking younger Australians for doing their part to accelerate the COVID-19 vaccination rates in this country.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-may-never-achieve-long-term-global-herd-immunity-for-covid-but-if-were-all-vaccinated-well-be-safe-from-the-worst-159821">We may never achieve long-term global herd immunity for COVID. But if we're all vaccinated, we'll be safe from the worst</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/162927/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diego S. Silva does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The rules around allocation, and the enforcement of those rules, can’t rest with each individual. Responsibility lies with those in charge of delivering vaccines.Diego S. Silva, Lecturer, Sydney Health Ethics, Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1621812021-06-20T20:19:21Z2021-06-20T20:19:21ZCOVID vaccination has turned into a ‘battle of the brands’. But not everyone’s buying it<figure><img src="https://images.theconversation.com/files/406934/original/file-20210617-15-1k2ng4i.JPG?ixlib=rb-1.1.0&rect=3%2C0%2C1012%2C736&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.etsy.com/au/listing/1007181200/moderna-vaccinated-shirt-house-pfizer?ga_order=most_relevant&ga_search_type=all&ga_view_type=gallery&ga_search_query=vaccination+t+shirts+pfizer+moderna&ref=sr_gallery-1-2&organic_search_click=1&pro=1">Screenshot/MarigoldCustom/Etsy</a></span></figcaption></figure><p>When we were hanging out for a COVID-19 vaccine in 2020, it was a bit like a horse race. We asked ourselves which vaccine would get over the line to win, and how quickly. Then, as multiple vaccines began reporting results from clinical trials, the race turned to which could offer superior efficacy and safety.</p>
<p>Flash forward to 2021, with multiple safe and effective vaccines approved, parts of the globe are experiencing “<a href="https://economictimes.indiatimes.com/definition/brand-tribe">brand tribalism</a>”. Which <a href="https://www.nbcnews.com/pop-culture/viral/team-pfizer-moderna-or-johnson-vaccine-rivalries-are-taking-over-n1263463">brand</a> of vaccine you want, or <a href="https://www.facebook.com/watch/?v=1003749933730249">can get</a>, has become a hot issue.</p>
<p>In the <a href="https://www.nbcnews.com/pop-culture/viral/team-pfizer-moderna-or-johnson-vaccine-rivalries-are-taking-over-n1263463">United States</a>, young vaccinators post their vaccine “team” or “tribe” preferences on social media, saying, “<a href="https://www.tiktok.com/@idrinkurmilkshake/video/6946023620133031173?referer_url=https%3A%2F%2Fwww.nbcnews.com%2F&referer_video_id=6946023620133031173&refer=embed">only hot people get the Pfizer Vaccine</a>”.</p>
<hr>
<p><iframe id="tc-infographic-589" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/589/70677a6f0fe00ba143dbc903aec539b7d2894b58/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p>In <a href="https://medanthucl.com/2021/05/06/vaccine-envy-and-vaccine-snobbery-why-we-look-a-gift-horse-in-the-mouth-when-it-comes-to-the-covid-19-vaccine/">Britain</a>, the Oxford-AstraZeneca vaccine invokes patriotism as well as warm feelings about its not-for-profit roots, even as some consumers prefer the “fancier” Pfizer vaccine. </p>
<p>In <a href="https://medanthucl.com/2021/05/13/not-the-chinese-im-a-pfizer-girl-the-covert-politics-of-pharmaceutical-branding-in-covid-struck-hungary/">Hungary</a>, fraught cold war politics have resurfaced as consumers can be vaccinated with one developed in the East or West.</p>
<p>In Australia, we’ve seen something different. Since the move away from the AstraZeneca vaccine for people under 50 <a href="https://theconversation.com/new-setback-for-vaccine-rollout-with-astrazeneca-not-advised-for-people-under-50-158661">announced in April</a>, brand preferences became about safety rather than efficacy. </p>
<p>However, data from our research currently under peer-review and reports from <a href="https://www.theguardian.com/australia-news/2021/jun/10/boomers-had-their-chance-under-40s-getting-pfizer-vaccine-in-nsw-despite-not-being-eligible">elsewhere</a> show younger and ineligible people are still stumping up to try and get vaccinated with whatever vaccine they can get. </p>
<h2>The public isn’t so tuned in to flu vaccine brands</h2>
<p>Having numerous brands of a particular vaccine is not new. Every year, <a href="https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.health.gov.au%2Fsites%2Fdefault%2Ffiles%2Fdocuments%2F2021%2F06%2Fatagi-advice-on-seasonal-influenza-vaccines-in-2021.pdf&data=04%7C01%7Ckatie.attwell%40uwa.edu.au%7Cd13fd55f2155495a3a2908d92bc5d91f%7C05894af0cb2846d8871674cdb46e2226%7C1%7C1%7C637588951032235710%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=g7paH1F%2B97%2Ff76w0pn8LLOyNl9QhZJJCn9GP6uKzWI8%3D&reserved=0">multiple brands</a> of influenza vaccines are used across various age groups. </p>
<p>One of us (Carlson) has been interviewing people about influenza vaccination for over five years, and no participant has told her they prefer a specific brand. </p>
<p>Things are different with COVID-19 vaccines, as people are increasingly aware of the different brands available to them and others. Through our <a href="https://www.uwa.edu.au/projects/vaxpol-lab/coronavax-project">Coronavax</a> project, we are continually hearing brand names mentioned. </p>
<p>Yet some participants challenge the focus on brands. Alma*, a 50-year-old doctor, told us:</p>
<blockquote>
<p>No one normally cares what brand of vaccine you get! With the flu vaccination […] people don’t start quizzing me on “what brand is this one?”</p>
</blockquote>
<p>Other participants, such as 71-year-old Frank*, were critical of the emphasis on brands. When asked his opinion on under 50s receiving Pfizer and over 50s receiving AstraZeneca, he turned the tables. He asked his interviewer (McKenzie) if she had received her flu vaccination this year (she had) and whether she knew which brand she had received (she did not).</p>
<p>Others expressed some brand preferences, and all were very aware of the different brands.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1395532532087627779"}"></div></p>
<p>The difference with flu vaccines, we hypothesise, is that although health-care providers are told about the different influenza vaccine brands so they can safely vaccinate people with the age-appropriate vaccine, the brands themselves are never front page news. </p>
<p>Flu vaccine brands are only ever sold to consumers as “the” flu vaccine. But COVID-19 vaccine brands feel like a buffet in which consumers don’t actually have much choice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/which-covid-vaccine-is-best-heres-why-thats-really-hard-to-answer-161185">Which COVID vaccine is best? Here's why that's really hard to answer</a>
</strong>
</em>
</p>
<hr>
<h2>Vaccine preferences in Australia</h2>
<p>International examples of COVID vaccine “teams” and people sharing their vaccine allegiances don’t directly translate to Australia. That’s because here, brand availability cannot be divorced from systemic and vaccine supply problems, such as not having enough of the appropriate vaccines for the specific age groups requiring them. </p>
<p>So in Australia, we don’t see brand tribalism as a fun expression of identity that can help orient everyone towards vaccinating. </p>
<p>Rather, brand preferences in Australia have developed through changing vaccine recommendations, and positive or negative <a href="https://link.springer.com/article/10.1007/s10198-021-01296-y">news coverage</a>. </p>
<p>In this imperfect scenario, governments need to keep backing the available vaccines that people can safely receive according to their age and risk profile, not <a href="https://www.theguardian.com/australia-news/2021/may/20/do-not-wait-to-be-vaccinated-greg-hunt-says-after-earlier-comments-sparked-confusion">encouraging people to wait</a> for new ones.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-astrazeneca-advice-is-a-safer-path-but-its-damaged-vaccine-confidence-the-government-must-urgently-restore-it-158763">New AstraZeneca advice is a safer path, but it's damaged vaccine confidence. The government must urgently restore it</a>
</strong>
</em>
</p>
<hr>
<h2>Any pros of brand awareness?</h2>
<p>One of the few benefits in the brand “team” wars is Australians are generally more aware of the science behind the development and safety of vaccines. </p>
<p>Most people we interviewed had recently learnt more about the science of vaccination. And most planned on being vaccinated with what was available to them, when it was (easily) available.</p>
<p>We hope this improved scientific literacy can help people appreciate the expertise that goes into creating vaccines, as well as the work of people like us who study their rollout, acceptance and uptake.</p>
<p>However, brand preference tribalism isn’t going to help Australia get vaccinated. Our <a href="https://www.smh.com.au/world/europe/zero-covid-countries-face-genuine-dilemma-about-how-to-open-up-who-20210608-p57yyg.html">unique situation</a> of (necessary) directives about specific vaccine brands for different ages, our low rates of disease, and the <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">increasing cut-off age for the AstraZeneca vaccine</a> announced recently have contributed to a broken roll-out strategy. </p>
<p>The conversations we need to keep having about brands are difficult ones. We are on quicksand and science keeps evolving. The most important message isn’t about which team is better. It’s about having a responsive system that cares about people. It changes things up when it needs to, however challenging that makes our vaccine rollout. </p>
<hr>
<p>
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<strong>
Read more:
<a href="https://theconversation.com/diverse-spokespeople-and-humour-how-the-governments-next-ad-campaign-could-boost-covid-vaccine-uptake-162240">Diverse spokespeople and humour: how the government's next ad campaign could boost COVID vaccine uptake</a>
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<h2>What we can do right now</h2>
<p>The best thing we can do is to tone down the brand narrative within the significant constraints we face. All COVID-19 vaccines are safe and effective, and if the disease profile of our country changes, then the recommendations about who should have which vaccine may change again. All COVID-19 vaccines protect and benefit individuals and communities. </p>
<p>Most importantly, all Australians benefit when we can safely reopen to the world and to our local businesses and communities. Without painful lockdowns, vaccines are all we have to look after ourselves and each other. We’re on that team.</p>
<p>*<em>All names of research participants are pseudonyms.</em></p><img src="https://counter.theconversation.com/content/162181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Attwell receives funding from the Australian Research Council and the WA Department of Health. She is currently funded by ARC Discovery Early Career Researcher Award DE1901000158. She is a member of a government advisory committee, the Australian Technical Advisory Group on Immunisation (ATAGI) COVID-19 Working Group. She is a specialist advisor to the Therapeutic Goods Administration. All views presented in this article are her own and not representative of any other organisation.</span></em></p><p class="fine-print"><em><span>Lara McKenzie receives funding from the WA Department of Health. All views presented in this article are her own and not representative of any other organisation.</span></em></p><p class="fine-print"><em><span>Samantha Carlson receives funding from the WA Department of Health. All views presented in this article are her own and not representative of any other organisation. </span></em></p>In Australia, a preference for a particular brand of COVID vaccine is likely to change, depending on the latest health advice, and media reports.Katie Attwell, Senior Lecturer, The University of Western AustraliaLara McKenzie, Research Fellow, School of Social Sciences, The University of Western AustraliaSamantha Carlson, Post Doctoral Research Officer, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.