The promise of vaccines – prevention, safety, renewal – always made the COVID-19 vaccine rollout susceptible to politicisation. Simmering tensions between the commonwealth and state/territory governments finally boiled over yesterday where some politicians entered into a blame game around the slower-than-expected vaccine rollout.
So, should the federal government increase the pace of rollout?
There are some good reasons not to rush. Sure, we want to see Australians vaccinated as quickly as possible. That need was illustrated this week when the QLD cluster saw cases in the community when then forced the cancellation of the Byron Bay Blues Festival. However, we should not call on the government to increase the pace of rollout. In making this call, I consider complexity in implementation, federal and state coordination capacity, service quality and safety, and global equity.
Here are my reasons:
There’s a supply issue. We lack the supply we were expecting, which also affects capacity to plan.
This slower pace was expected. There is a large and complex rollout that is being managed by the federal government more than usual. Teething problems were predicted from day one. The Minister for Health announced an aim to vaccinate all who wanted to be vaccinated by October. This was always unrealistic. In December, Labor insisted on bringing it forward and the government responded without a good understanding of what it takes. It effectively reduced the time to prepare and have the various systems in place like a booking system, training staff, adequate communication to states etc.
There are logistical challenges in vaccinating the workforce. You cannot vaccinate the entire ward on within a single week. Planners need to account for possible bulk sick leave from systemic vaccine reactions in a percentage of vaccinees. They must ensure there are enough staff to cover a ward. Getting a vaccine right now requires planets to align – the time the vaccine is available lines up with a shift worker’s time to be vaccinated ideally in the days prior to days off.
The booking systems have teething problems, as most new systems do.
A politically pressured and rushed vaccination program is a less safe one. It is important to respect the need for good process around consent, vaccine delivery safety. We have already seen problems here, like a dosing administration error earlier on. Also, bad clinic experiences are more likely with a rush. These contribute to hesitancy. One person whose consent process was unsatisfactory may be another 20 people getting put off if they broadly share that experience.
Also there is the issue of vaccine safety signals – this is an evolving space. Clinicians are likely to find guidance about contraindications changes. This takes time to implement into all the screening and consent systems.
Our patience with the pain of rollout is the potential gain of our neighbours. A national demand for vaccines now will also affect willingness to send vaccine to PNG where it’s greatly needed with the outbreak there. We have good control of COVID and are likely to get control back in the next weeks. Australia can afford to wait. PNG cannot. Australia is helping the region, but the timing of offering vaccines elsewhere is a political consideration.
We should put our situation in perspective and advocate for global and regional equity. The costs of the pandemic will be greatly reduced if all nations reach reasonable coverage, not just the wealthy ones able to purchase early and stockpile.
All of this is said with the caveat that the federal government were, in my view, wrong to insist on administering much more of the program than they normally do. Most other new and routine vaccination programs like HPV and yearly influenza are done successfully by states and territories. But the commonwealth are overseeing GP and aged-care based rollout. There is not a specific plan for mass vaccination centres that increase access, although we will hopefully see them. They have not involved nurses (the main vaccinators in Australia) sufficiently in their planning and enable them to work in their scope of practice, particularly Nurse Practitioners.
So what should we call for?
- That the federal government consider relinquishing more implementation control to the states.
- The states are enabled to increase access (and equity of access) by having mass vaccination clinics that enable drop-in
- Enable suitably qualified nurse practitioners to give vaccine independently
- The federal government to continue to assist PNG with vaccine supply as soon as possible
Hopefully with the teething problems addressed, we can get on without the political bickering and with a common sense of purpose, problem solving, clear communication, and cooperation. The main aim is to vaccinate Australians and to do it well.
For strategies for increasing vaccine uptake once supply is stable, see Working paper: A COVID-19 vaccination strategy to support uptake amongst Australians
Human factors 