Australia could have prepared a more ambitious vaccine strategy than most. So what went wrong? | Health

Australia’s vaccine rollout is being deemed a failure for not meeting early ambitious targets. The stark contrasts between announcements and realities have left the public confused and undermined trust in the vaccine strategy, while blame games over who – or what – is responsible for the slow rollout dominate the media.

You can only roll out a vaccine as fast as the supply chain and delivery infrastructure allow. Given our delayed start compared with other nations, Australia had the opportunity to prepare a more detailed and ambitious vaccination strategy than most. We also had the luxury of including more complex, personalised, logistical elements – community-based vaccine delivery through local GPs. These were opportunities afforded us by the hard work all Australians put into containing community transmission.

The lead time also allowed Australia to learn from the logistical experience of other countries. Yet, if we look at aged care, a priority group across the globe, we are a long way short of resident and staff vaccination targets. What went wrong for us? And was it in setting overly ambitious targets, or in the delivery?

Vaccine supply has been identified by the government as the main driver in our failure to meet the short-term target of 4m jabs by April. The first phases of the rollout focused on imported Pfizer and AstraZeneca vaccines, with 3.8m doses of AstraZeneca scheduled to arrive in early 2021.

This strategy bought time for Australian production of AstraZeneca to come into full swing. But instead, the AstraZeneca deliveries to Australia are behind schedule, short by 3.1m doses.

There was, of course, a well-publicised EU refusal of a shipment of 250,000 doses to Australia in March for a shipment that was reportedly already reduced in size over fears a larger shipment would be more likely to be rejected. This shipment alone was not going to impact short-term targets, but our prime minister now says that we were given a clear message to not submit further export requests. Could Australia have had subsequent requests approved if we had asked? Only the EU Commission knows the answer to that, but what matters to us now is the impact this has had on our vaccine rollout progress, and the confusion these contradictory stories can engender.

Meeting short-term program targets is often challenging during the rollout of any strategy, logistical realities often play out less predictably in the short term but can average out over the longer term. The Australian government is holding firm on its October target for a first jab for all Australian adults, but, epidemiologically speaking, it is not the one of most immediate importance.

What really matters to all of us is when our exposed frontline workers and most vulnerable populations are covered, for this is where our greatest risk lies – not only from infection and transmission and the costs associated with that, but also the collateral damage caused by the heavier containment measures that tend to be employed in the absence of vaccine coverage. Victoria reported 93% of hotel quarantine workers had completed their first jab last week, with second doses under way. We need more of this reporting at the national level so we can track progress milestones.

While many uncertainties remain,there are a few knowns. Phase 1a, and to some degree phase 1b, are not typical of subsequent phases. These early phases include workplace vaccinations, which can provide some conveniences in an easily identified and managed population, but can be challenging to coordinate, given the risk of having too many workers away from essential work at the same time.

General practitioners, the focus for wider community reach in phase 1b for, have voiced a number of frustrations: from managing the expectations of patients who turned up in droves on the strength of government communications, to the number of doses allocated and vaccines failing to arrive. State-run vaccine centres are part of the vaccine strategy, with Victoria well down the path of establishing mass vaccination venues.

At the very least, there have been serious communication breakdowns with key partners, the states and GPs, during the rollout that is clouding public messaging.

So how can we rebuild public confidence?

The very specific populations targeted in phase 1a and 1b don’t necessarily provide a useful basis to predict the rollout pace for subsequent phases. This is good news.

CSL will soon meet its commitment to produce at least 1m doses a week, with two key areas identified where the process can be expedited without compromising quality or safety: the complex approvals and clearance process for each batch and getting the bulk vaccine packaged and ready for distribution. As the supply of vaccine is securedand the number of GPs scales up and mass vaccination facilities come online, we will see a rapid change in daily vaccination rates. We could double the number of jabs delivered in March within this first half of April.

So let’s keep our eye on the vaccination horizon. Once we are beyond phase 1 with the vaccine pipeline operating smoothly, the most significant determinant of achieving the October goal of all adults with at least one jab will come down to the willingness of people to come forward. We have important decisions to be made in the rollout for ways that may reduce the extremely rare, but serious side-effects from AstraZeneca, and this should be the focus of communications now, not missed targets from weeks ago.

Australia is a world leader in vaccine campaign success. Let us hope the problems with the rollout do not jeopardise that.

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