Australia COVID Recalibration 2021
A commentary by Dr Harry Majewski 13 September 2021.
Australia needs to reflect and recalibrate its response to COVID. This is being done but comparison data from other countries may help form views (see Table and the following commentary).
Commentary:
Vaccination numbers are not the whole story
Australia has a very low vaccination rate. Australia is aiming for single dose targets of 70% for those above 16 years old as soon as possible. But even if these are reached even for double dose, the fully vaccinated will be below the best in the comparison group in the Table. A 70% over 16 years old target who are double vaccinated equates to 57% of the population. This is not a herd immunity number and we are even not there yet.
Even with countries in the comparison group with high vaccination rates, deaths and patients in ICU are high. In some cases, very high such as in Israel and USA. The overall numbers hide issues in vaccine distribution. The groups most likely to die or be hospitalised remain unvaccinated. They also have poor personal protection and opportunity for distancing. The push to have high raw vaccine numbers should not dilute the effort to target vulnerable groups and maintain personal protective actions. In the end, deaths will be almost all unvaccinated people exposed to COVID. The two factors are no vaccine and high exposure chance. We need to act on both.
ICU beds should not be near capacity if we are even half good
Looking at the comparison set the COVID Intensive care occupancy (ICU) currently in Australia is below all countries except New Zealand. We have had time to plan and should be planning systems, processes, people and equipment. It would be disappointing that our health system could not reach the capabilities of any of the comparison set of countries.
Lockdowns and Border closures have helped
COVID Deaths and patients in ICU are low in Australia compared to the comparison group because of lockdowns and border closures. But even in some countries with fewer internal or external movement barriers (e.g., Germany) there is not a massive difference in deaths or patients in ICU with Australia. Other things have helped including personal protection responsibility, vaccination, the summer season and quality of care. We can influence these and are lucky with the change of seasons from Winter to Spring.
Where are we really?
We had a vaccine priority plan. It wasn’t followed. One reason was the inability to deliver enough vaccines. We hear time and time again of priority groups being poorly vaccinated. What is the plan now? Getting everyone vaccinated or at least those most likely to spread COVID (younger adults) or to have a vaccine shield for the vulnerable (older adults). If it is both, do we need to worry about timing and best use for today? The confusion is compounded by supply issues. It is convenient to blame vaccine hesitancy, but the hesitancy is also a product of poor messaging.
Transparency leads to confusion
We have a scientific and medical infrastructure that makes risk-based decisions every day on the use of medicines. We rely on experts appropriately informed to make decisions. We don’t hear about their assessments and side effects and risk for new drugs. In the case of the COVID vaccines it was different. We were publicly exposed to risk and side effects. The scrutiny was more intense than previously for other medicines. Yet the scientific assessments were on the same basis of risk and protection for other medicines. The process recommended the use of three vaccines in Australia. Yet many were fearful about this risk calculation. Maybe they would have been fearful of previous decisions on other medicines as well if they had been exposed to as much information. This is part of the confusion. The media hasn’t helped, looking for a sensation instead of a rational explanation and benchmarking.
Recalibrating what is acceptable.
Australians catch influenza every year. In some years in Australia influenza is not well controlled. In 2017, a peak year, the death rate was estimated to be 1,255 persons largely skewed to the elderly. The influenza vaccines that year were not so good. This is not very different death outcome to COVID so far. However, our mindsets and reactions have been different. We need to change mindsets to living with COVID.
Every chance of being best in group
The recalibration of the Australian Plan needs to be bigger than what we see today. A key is high vaccination rate overall and a high vaccine shield for the vulnerable. The mechanics of this need to be what a clever country would do. Clear messaging, active outreach and harnessing the strengths of the multicultural society. However, the vaccine shield needs reinforcing. We still need barriers to protect those most vulnerable. Whilst it may be popular to remove all barriers, it is also inadvisable from the Table data
A target of herd immunity is a target that cannot be reached in the foreseeable future. So, living with COVID is our future. Being clear about what this looks like is important and to date the message is weak. With vaccines, there still needs to be a focus on public health protections: masks, clean air, social distancing and not too much gathering. That message needs to be clear. Otherwise, there will be an explosion as seen in some countries listed in the Table with high vaccination rates at the same time as high COVID complications.
