If our rollout proceeds, using two different vaccines, we might create a society of suspicion and division: vaccinated v non-vaccinated, Pfizer v AstraZeneca. Most other countries need to mass vaccinate now but Australia doesn’t. We should forget AstraZeneca and wait for higher efficacy vaccines to avoid having lower overall immunity than those other countries.
Many countries desperately need the Covid-19 vaccines. Except for frontline workers and the vulnerable, Australia does not have such urgency. Yet the federal government is rushing Australia’s rollout. The plan needs to be modified to use only high efficacy vaccines, like Pfizer, to ensure we have enough immunity and avoid a society divided on the basis of vaccine status.
Vaccinations in Australia started on Monday, 22 February. The Conversation explains Australia’s strategy:
“Australia has secured access to 20 million doses of the Pfizer/BioNTech vaccine, 53.8 million doses of the Oxford/AstraZeneca vaccine, and 51 million doses of the Novavax vaccine. All of these require two doses for maximum effectiveness.
The federal government plans to begin vaccinating groups at high risk with the Pfizer/BioNTech vaccine, then use the AstraZeneca vaccine for the remainder of the population.
The Novavax vaccine may be used at a later date.”
The use of AstraZeneca is rushed and flawed
Since September, the federal government has widely and confidently promoted Australia’s access to vaccines. One senses the PM is pinning his hopes on the rollout as a crowning achievement and one that which will deflect attention from arguments about federal government shirking responsibility for quarantine.
With an efficacy rate of 95%, the early roll out of the Pfizer vaccine to frontline quarantine and health workers, combined with a continuation of our quarantine system, should quickly solve the problems of community outbreaks.
Provided complacency does not set in with these workers, Australia may soon see the end of lockdowns and closed state borders, if not the end of closed international borders.
Speed is not the issue. Australia could have everyone vaccinated tomorrow and it would make little difference to our infection rate. We currently only have a few dozen cases in Australia.
A major issue with the rollout is that the AstraZeneca vaccine to be offered to most Australians has an efficacy rate quoted as low as 62%. This means the failed immunity rate for AstraZeneca (38%) is more than seven times the failed immunity rate of Pfizer (5%).
This raises concerns about whether we can reach widespread immunity, about when we will be able to open up to the rest of the world and whether divisions based on people’s vaccinations status will appear.
It is not clear when the Pfizer vaccines will be available as the doses are arriving in batches, presumably over coming months. On the other hand, on February 12 the Prime Minister proudly announced that the AstraZeneca vaccine would be made by CSL in Melbourne, and be available “in a matter of weeks”.
Thus, it is possible that both vaccines may be rolled out to different risk groups at the same time. However, as we explain later, it would be understandable if some or many Australians did not want to take up the AstraZeneca option: its use at all needs to be queried. Australia does not have an urgent need to use it, and instead the rollout can be delayed so that all can be vaccinated using Pfizer or equivalent.
A major concern is that if the rollout proceeds as planned, using two different vaccines, we might create an Australian society of suspicion and division: vaccinated v non-vaccinated, Pfizer v AstraZeneca. Could we end up with a situation where one sibling is allowed into an aged care facility to see their parent, while another sibling isn’t? Could some people be barred from hospitals or aircraft?
Even with the highly rated vaccines many uncertainties remain, meaning that quarantining and international travel restrictions will remain in some form or other for the foreseeable future.
No vaccine has ever reached 100% effectiveness. Problems will continue until we vaccinate extensively worldwide with high efficacy vaccines and we reach the ‘herd immunity’ stage, where the virus has been eliminated, if not eradicated. That means every country has to work quickly to conquer the virus to reduce the chance of dangerous new mutations.
The Covid vaccines work for the countries that need it
The Covid problems in some of the worst hit countries, including the US, UK and Israel, are well documented. They began vaccinating some weeks ago: US and Israel with the Pfizer and Moderna vaccines, UK with AstraZeneca and Pfizer. Other countries have also started vaccinating. Here is a very useful link to vaccinations by country.
Israel is the world leader. Nearly a third of its citizens have been vaccinated with two doses and nearly a half have received one dose. Since its rollout started, Israel’s daily new Covid cases, number of active cases and daily deaths have clearly slowed. The same pattern has been repeated in the UK, the US and elsewhere. The vaccines appear to be working.
But not all countries are so lucky. The New York Times on 9 February reported: “In Bolivia, bodies are piling up at homes and on the streets again.”
Many countries couldn’t jump to the front of the vaccine queue or afford the most efficacious options such as Pfizer or Moderna, or perhaps any vaccine at all. Doses of the Russian Sputnik V are now being given in Bolivia but the rollout will be slow. Many developing countries, however, have no rollout at all; they might not yet have anything to inject.
There have been and are many warnings about vaccine nationalism and how not helping the less-privileged countries combat and control the virus could prolong the pandemic worldwide.
The race is on … vaccines vs variants. The global response will determine the winner
Thus in countries where the virus remains out of control, more dangerous mutations may develop, with the potential of making their way through the borders of well-off countries and rendering their vaccination programs useless.
Australia’s superfluous AstraZeneca vaccines could be redirected to these countries, as even with a lower efficacy rate, it will still slow the virus’s progress. Further, given the propensity for mutations to develop, nobody is safe until everybody is safe.
Vaccines help, but not if you have no infections in the community
The chance of anyone in the community getting Covid in Australia is close to zero.
However, if Australia were to stop quarantining and open our international borders, Covid cases could explode. Our planned vaccination rollout would not be in time to prevent widespread illness and crises in our hospitals.
With the imminent vaccinating of our frontline workers and the continuation of our current prevention policies, the chance of anyone in the community getting Covid should reduce even further.
Australia’s tackling of Covid has been phenomenal. Most jurisdictions have gone for several months with zero or next to zero community cases. As I write (24/2/21), nationwide we have 65 active cases, with 51 overseas arrivals. NZ has 62 active cases, of which 51 are overseas arrivals. The US has 9.3 million active cases and the UK 1.7 million.
Australia does not have a Covid-19 problem that requires immediate mass vaccination using an inferior vaccine.
Since mid-October 2020 Australia has had only 1,538 Covid cases and five deaths. Of the cases in that period, 1,171 were infections in overseas arrivals, leaving just 367 confirmed locally acquired cases in four months.
If this pattern continued, over the next four months we would expect a similar number, meaning that the chance of a positive test in the community is about 367 in 25.5 million or 0.00144% or about 14.4 chances in a million. (The figure for NZ is even lower.)
The imminent rollout of frontline workers should reduce the risk further, provided our international arrivals remain controlled.
This emphasises that the US and the UK and most other countries have to mass vaccinate as soon as possible but that Australia and NZ don’t.
Our decision makers have to make sure that the mass rollout is done for the right reasons: we should not be vaccinating “just because we can” and we certainly should not be doing it for political reasons and we certainly should not continue knowing that one vaccine may be below the standard required.
The federal government has defined its priority list. The first group of 678,000 comprises frontline workers and aged care residents and staff. The second group of 6,139,000 targets the vulnerable, including the elderly and those with underlying medical conditions.
Between the two groups we have about 30% of the population covered. They could be given the Pfizer vaccine, assuming enough doses arrive in Australia.
It is not necessary to vaccinate the 70% of the rest of the community yet, given that we will have a strong quarantine system in place. An ethical question is whether anyone in Australia should be given the AstraZeneca vaccine with its lower effectivity?
A rethink of the rollout could lead to a much better outcome. In Part 2 we explain why Australia is unlikely to achieve herd immunity under the current plan.
Robin Boyle lectured in statistics at Deakin University and preceding institutes for three decades until 2009. His academic background in mathematics, economics and finance, as well as statistics, led him to developing teaching software in those areas and to be widely sought after as a textbook author.
Comments
11 responses to “Rethinking Australia’s Covid vaccine rollout: beware a two-tier system. Part 1”
I recommend Giliad Atzmon’s current post on mass vaccination and the Israeli mutant. I think the biggest problem is the cover-up. The cover-up of the origin of Covid-19 and the cover-up of the dangers of the vaccines.
Mr Boyle thanks for this.
I am afraid I do not understand it.
Starting with: ‘the early roll out of the Pfizer vaccine to frontline quarantine and health workers, combined with a continuation of our quarantine system, should quickly solve the problems of community outbreaks.’
How does the former part relate to Professor Dwyer’s post last week: ‘None of the vaccines has been shown to produce ‘sterilising immunity”’ etc. Or his earlier emphasis on the merit of vaccines being reducing effects, rather than facts, of Covid in individuals?
e.g Implication for herd immunity?
Then there is the sociological element – community conformance with public health requests. Despite the optics of two vaccines, surely public perceptions about the bona fides of policy are more influenced by ongoing abuses of power in several States, not being NSW (which has a similar issue in another domain). And destructive prattle from underperforming Premiers.
If so, the belief being promoted is political not medical – vaccines ‘will stop Qld, WA etc. abusing power’. They may get the Commonwealth off the hook.
But not for quarantine. Yes it bears Constitutional responsibility but due to Premier’s egos – and underestimation of Mr Morrison – it carries neither functional nor actual duty (eg. inspecting what States have done to exercise the function).
Rather, vaccines might cover-up Commonwealth negligence in not challenging flagrant State abuses via the courts, or of demanding States do the obvious – Governments listen to ‘the advice’ rather than have narrow experts set enormously broad laws. The former being what most Premiers dishonestly claim their States do.
True Covid is virtually absent in Australia. And has been since late last year.
Yet the absence of Covid in several cities did not prevent them, and around 5 million people, being locked down.
In that context the need for vaccines – like moving quarantine out of capital cities – is political: they stop lockdowns. Because the absence of Covid has been proven incapable of doing so.
Premiers who are either panic stricken or have failed to adequately resource public health – who have not taken the pandemic seriously enough– are holding a gun at the head of Australians.
That is the Commonwealth’s failure.
Best wishes
Hi Petal.
Re ‘the early roll out of the Pfizer vaccine to frontline quarantine and health workers, combined with a continuation of our quarantine system, should quickly solve the problems of community outbreaks.’
The hope is as follows.
First, more countries vaccinating and the assumption the Australian government will insist on vaccination AND negative tests for people before they embark for Australia should lead, everything else being equal, to fewer infected arrivals.
Second, if frontline workers are vaccinated, and assuming the Pfizer efficacy is accurate, and the same standard of quarantining, there should be a reduction in frontline workers becoming infected. There is a risk they might become infected but be asymptotic.
However, all in all the transmissions from arrivals to quarantine workers should be greatly reduced. (We have to hope though that those workers don’t become complacent and start acting as if they are virus free; some might not be.)
Thus, with fewer frontline infections, there should be reduced transmission into the community, reducing the need for lockdowns and closed state borders.
Mr Boyle: thanks. look forward to next posts.
My question relates to whether vaccination has any ‘become-infected’ effect on front line/quarantine workers. And if so why.
Eg.
a.whether vaccination prevents a person becoming infected;
b. whether vaccination reduces a person’s ability to transmit infection.
Other posts suggest vaccination does not achieve (a) yet reduces the adverse effects in an individual. Do those effects determine infectiousness?
And therefore vaccination of person (1) reduces probability of them infecting (2).
If not demonstrably and quantifiably so, there is a new issue arising from more people becoming asymptomatic via vaccination.
Because it supposedly was fear of undetected asymptomatic people that just led to the lockdown of nearly 10 million Australians and border closures for 16? transmission-within community cases.
If asymptomatic people are to be feared, vaccination is likely to have a personal benefit for, and only for, those who get vaccinated. So people should get vaccinated and not try to ‘free ride’ on mythical herd immunity?
If they are not be be feared, there is yet another wtf moment coming.
Hot on the heels of some States telling the High Court, in October, 28 days of no interstate community transmission is needed to be ‘safe’ to open borders, then opening borders to Qld and Vic within half that time. But not to NSW.
Regards
This is what Switzerland, a country that has had its fair share of virus cases being centrally located in Europe thinks of AstraZeneca
“A lack of green light from medicines regulator Swissmedic could see 5.3 million doses ordered by Switzerland sent elsewhere.”
https://www.swissinfo.ch/eng/switzerland-could-sell-or-give-away-astrazeneca-doses-if-regulator-dithers/46388016
https://www.reuters.com/article/health-coronavirus-swiss-astrazeneca-idUSL1N2KR04M
Swissmedic is one of the highest standards in the world but the vaccine has still not passed there.
Since the beginning, the reason why the government quickly lined up this vaccine may be because there were Liberal Party connections, so its another potential mates deal.
” the Director of Government Affairs at the company is one Kieran Schneemann, former Australian Pharmacy Guild lobbyist and Chief of Staff in the Industry, Science and Finance portfolios during the Howard government”.
https://www.patreon.com/posts/mr-morrison-and-40625889
What concerns me is that the government are not giving a choice to people, and it is still not clear as to whether it works in the over 65 category, at least from Switzerland with its high standards.
Is this just part of another Morrison marketing exercise? Haste to get the vaccine rollout going? Appearances not reality?
https://www.drugwatch.com/manufacturers/astrazeneca/
Robin Boyle here. Some very interesting comments have been posted. Two more parts are to come, and they might address some/all of the issues raised.
Thanks Robin
Sorry for the profuse messaging, last comment, I promise.
We need to take into consideration the cold storage and transport of the Pfizer vaccine vs a locally produced and normal cold-chain transport of the Oxford-AZ vaccine. There will inevitably be problems with the cold storage and international transport if not local distribution of the former. A Pfizer vaccine inactivated by disruptions to its storage and transport might as well be placebo. The real world effective efficacy rate IN AUSTRALIA (with our distance from Europe and vast geographical area) between the two vaccines may be very different (with the more stable Oxford-AZ one being favourably competitive), especially if the vaccine schedule requires multiple vaccines with prolonged intervening intervals – you want someone to show up for a second dose at 8 weeks or 12 weeks? Ever looked at the number of people who don’t get their second dose of Hepatitis A or even the number of infants who are late for their 12-months vaccinations? All very well and good for vaccines that don’t require cold storage and sterile storage (yes, multi-dosing means repeatedly putting a needle into the same vial so you need strict sterile conditions for any opened vials that are not used because a patient misses their appointment), and for vaccines that are in continuous demand and with ample reserves in their supply.
The multi-dosing mistake is another certain human error that should have the employers and aged care facility in the stocks instead of the doctor, who was first reported to be a GP now not – why is a doctor giving vaccines when usually the nurses give vaccines and are the ones who are trained to do them??? Is it just yet another marketing strategy and bureaucratic decision elevated above good practice, or some proof-of-concept thing to show that GPs and pharmacists can give these vaccines throughout Australia without problems?
If we decide (please read my comment below about the debate we are not having) to let SARS-CoV-2 into Australia it would certainly be better if we choose a vaccine with higher efficacy. If we decide not to, it would be better to have a vaccine that is easier to produce and distribute, AND it will surely improve the chances of us developing our own vaccine industry with jobs jobs JOBS!
One more point, feel free to censor this one if you feel the anti-vaxxers are dominating public health messaging:
If you are worried about Australians’ trust in their health and expert advice, you should answer their questions and address their concerns, not cover it up, overwhelm them with marketing and propaganda, and put them into the same irredeemable camp as the anti-vaxxers. You are simply undermining that trust because there are problems with the fast-tracking and emergency approvals of these vaccines, and like the Canadians who voted 100% that China has committed genocide based on the poor analyses of a religious fundamentalist you will not only lose trust and reputation, you will become much less effective and influential in the future.
I must disagree with the author on almost every aspect of this article, except for the observation that Australia has no need to rush its vaccination program following the effective eradication of the Coronavirus from the country. Barring a new outbreak that actually escapes from quarantine control, which recent outbreaks have not done – only spreading to family members and close contacts – we can afford to wait. But what we must wait for is more information on the side-effects and deaths resulting from the Pfizer vaccine around the world, which notably now exceed those from catching the infection in Israel. As it is an experimental and potentially risky method to induce immunity – which cannot even be properly called a “vaccine” – we have simply no idea of the long-term effects – for instance on the foetus in pregnant women, or on the body’s response to infections.
Also quite contrary to the author’s recommendations, the efficacy of the Astra Zeneca vaccine is now recognised as around 90% while its safety profile is completely different. The origin of the “95% vs 62%” comparison between the two types of vaccine was in the results of initial trials based on a mere 100 people who did NOT become infected with the virus out of 105 given the vaccine, in a group of 20,000 people – in which 105 taking the placebo developed the infection. Their exposure to the virus was purely accidental, and evidently minor. Meanwhile the AZ stats were based on the fact that no participants over 65 were included in initial trials, quite falsely presented as therefore ineffective in older people.
While it may be true that the government’s support for CSL and the AZ vaccine is favouring some mates, our support for the Pfizer vaccine is favouring some others in the US and in Israel – which has done a special deal with Pfizer to allow access to its citizens health data. This would presumably include the suppression of any negative results and adverse publicity.
But one last point, and a most important point – that it appears that since the start of January the rate of new CV cases in the US, UK and India has fallen by 75-80%, coinciding with but unconnected with the roll out of the vaccine. Herd immunity from natural infection appears to be the cause, as already acknowledged in India.
On a separate point: the real world effective efficacy rate of either vaccine is 100% in Australia because you simply won’t catch the virus here. Yes, yes, that isn’t how you define efficacy rates in a scientific study but you need to translate science into the real world.
Which means, of course, the two elderly Australians who suffered overdosage and those others who will suffer from side effects of the vaccinations they received, will have unnecessarily suffered those medical errors and adverse effects IF and only if we don’t let SARS-CoV-2 into Australia. If we do let the virus in the sure, the benefit outweighs the risk and adverse events.
The other point that arises from the fact we have no SARS-CoV-2 in Australia is, there’s no difference whether you get the Pfizer vaccine or the Oxford-AZ vaccine, you are simply participating in a public health measure and discharging your civic duty in slowing down any potential outbreaks as they surely will occur. Which also means there is no two-tier society as Mr Boyle fears – public health considerations are different to individual health considerations, just as you wouldn’t expect your GP to gatekeep your asthma medications because there are supply chain disruptions when you go to them.