The plan to inoculate Australia: How governments will vaccinate more than 16-million people in less than a year

By Matthew Elmas

Monday November 2, 2020

vaccine

As the Australian government reveals its COVID-19 immunisation plans, a resurgence in coronavirus infections around the world is defining a new set of stakes in the race towards a vaccine. The Mandarin examines how governments are drawing on cross-disciplinary expertise to solve the logistics challenge of a generation.

Everyday since the dawn of the COVID-19 pandemic, three questions have predominated nearly every global policy response: when will vaccines become available? How effective will they be? And how are we going to distribute them?

In Australia, where the federal government forecasts a mid-2021 vaccine, planning is already underway for the eventual deployment of tens of millions of doses, in what Department of Health secretary Brendan Murphy described last week as a society-wide effort.

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“This is a logistics challenge the likes of which we’ve never seen before,” Murphy told Senate Estimates.

No kidding. Under a new plan outlined by Health Minister Greg Hunt, a target of two-thirds of Australia’s population (16.5 million people) would be vaccinated in a two-dose schedule spread 30-days apart – all tracked by the national immunisation register.

Globally, as eleven vaccine candidates proceed through final phase-three trials and sixteen others undertake phase-two, nations are developing their own plans for expedited, progressive and ultimately population-wide delivery programs.

However, uncertainties abound as health experts warn fast-tracked vaccines are likely to have varying efficacy rates, presenting an ongoing challenge for governments balancing the public health response to the pandemic with safely inoculating a diversity of population groups.

The great race: COVID-19 vaccine strategies take shape 

Within this unprecedented rush to develop a COVID-19 vaccine sit the hopes of billions, as a global coronavirus resurgence becomes a spectre over the tail-end of 2020 – forcing the UK, France and Germany to reimpose national lockdowns this week.

While Australia and other nations have the virus under control, soaring infection rates elsewhere threaten an economically vital winding back of border and trade restrictions, which is increasingly unlikely to occur until significant portions of the world population is vaccinated.

Underscoring the need for a global response, but also highlighting divergent paths to eventual deployment; multilateral bodies like the UN are coordinating equitable vaccine access, while the world’s largest and most pandemic-ravaged economy, the United States, is mired in the uncertainty of an imminent federal election.

President Donald Trump has promised a military-enabled deployment of 100 million doses by the end of 2020, and Democratic candidate Joe Biden has committed to a federal-led strategy that would fund a series of state-administered medical assistance programs.

Both strategies are being developed for a federated system where as evidenced by Australia’s COVID-19 response success is defined by cooperation and power-interplay between multiple levels of government. However, US authorities face a much deeper challenge in higher infection rates, lower public healthcare coverage and rising public scepticism about vaccination.

“Given the prioritization, you can get a substantial proportion of the population if they want to get vaccinated, because that’s another challenge. We have the reluctance of people to get vaccinated,” Anthony Fauci said in an interview over the weekend.

Comparatively, Singapore has a similar level of control over the virus to Australia and is also developing a priority-based distribution model to vaccinate its population progressively – a prescient opportunity for nations with lower infection rates.

“[We] will take into consideration the characteristics of the vaccine, suitability for different population subgroups, and availability of the supply and other factors,” Singapore’s Minister for Health, Gan Kim Yong, said in September.

Yong explained a progressive strategy will allow Singapore to refine and adapt as more information about suitable vaccines, their effectiveness and public health impact become clear; a contrast with the United States, where the health landscape is spurring a sense of urgency from the White House.

“We’re not going to know anything, really, about not just long-term efficacy, but even relatively short-term efficacy; we’ll know that there’s efficacy for months but not necessarily for a year,” vaccinology professor and former CDC advisory committee member Paul Offit said last week.

From medicine to ethics and social science: the plan to inoculate Australia

Australia’s plan for the herculean task that is inoculating some 16.5 million people across a 7.62 million km² area is taking shape within the context of these global efforts, as local authorities press forward on a society-wide effort.

“We haven’t landed all of those plans yet,” Murphy told estimates. “We’re going to need experts in logistics to transport vaccines, we’re going to need teams stood-up in every state and territory … we’re planning to train up a whole army of additional nurse [immunisers].”

Australia’s COVID-19 Vaccine and Treatment Strategy, published back in August, outlined a similar set of priorities: a local supply chain audit; options for international vaccine procurement; and streamlined regulatory approvals.

It designated the Australian Technical Advisory Group on Immunisation (ATAGI) as responsible for providing advice on overall program development to cabinet, and in more recent mid-October and late-August meetings, ATAGI members were briefed on the developing vaccine strategy and agreed to form a working group to develop government advice on “safe, effective and equitable use” of COVID-19 vaccines.

Department of Health secretary Brendan Murphy says governments will develop demographic-specific plans (AAP).

The working group will comprise several non-ATAGI members with additional expertise in fields as diverse as ethics and social sciences, because vaccine deployment will require governments to think laterally, incorporating advice on geo-demographic and socio-economic factors.

For example, as Murphy has explained, individualised plans will be developed for healthcare workers, the elderly and school-aged children – all depending on what an eventual vaccine looks like.

“There will definitely be health care worker immunisation clinics set up at sites of healthcare work,” Murphy said. “GPs [general practitioners] will be used as they are already delivering most immunisations at the moment for the general community … we will need to establish specific teams to go into aged care facilities to immunise the staff, but also the residents, depending on whether the vaccine is safe and effective for the various population groups.”

Into the great unknown: Will a vaccine save-our-souls? 

Murphy’s comments underscore a key challenge for governments in Australia and around the world in deploying COVID-19 vaccines. Even after nearly a year of global efforts, there is still so much we don’t know about prospective vaccines, how they will affect diverse population groups, and whether or not they will offer sustainable protection against coronavirus.

It is, however, unlikely early vaccines will be a golden ticket to COVID-free societies, at least not according to the US’ Food and Drug Administration, which said in June it expects a COVID-19 vaccine would prevent disease or decrease its severity in at least 50% of those vaccinated.

“Some vaccines may not prevent transmission, their only benefit may be to prevent severe disease, that’s possible, in that case you would focus very quickly on the vulnerable,” Murphy said last week.

Vaccines are likely to affect diverse population groups differently, and even with varying efficacy, which means the number of likely doses needed to hit vaccination targets and the scope of approved drugs required to achieve coveted herd-immunity are still shrouded in doubt.

Such is the uncertainty that Department of Health officials told estimates last week they’re operating under a blank-cheque mandate of sorts, with Prime Minister Scott Morrison having already committed to a free vaccine for all Australian citizens.

“We’re acting under instruction to make sure we make this work and we make it work for everyone,” a Department of Health official said.

Distribution: Adaptive supply chains

Against uncertainty vaccine transport and storage will also be paramount, particularly because of Australia’s diverse climates, stretching across sprawling urban population centres and sparse regional and rural communities.

University of Melbourne senior lecturer in operations management, Lusheng Shao, says the Oxford vaccine Australia is set to receive must be transported at a temperature of around -2 degrees Celsius, but other vaccines will require different arrangements.

“The cold chain requirements are different for different vaccines due to their heterogeneous technologies,” Shao tells The Mandarin.

Should Australia need to procure other vaccines supply chains will need to be adaptive to varying cold chain solutions. For example, the US’ Moderna candidate must be stored at -20 degrees, and the Pfizer vaccine at -70 degrees.

“Australia is betting on a small number of vaccine candidates, primarily the ones from Oxford and The University of Queensland,” Shao says.

“While the temperature requirements for these vaccines are less stringent than their US competitors, no one can be certain that they will be successful.

“Once these vaccines fail, other vaccines such as Moderna and Pfizer may be secured, but this would present huge logistical challenges in light of the temperature requirement.”

Sovereign capability: Australian Made

The likely need for multiple vaccines, their specific storage and delivery requirements and likely efficacy on diverse population groups has incentivised Australia and other governments to begin building sovereign manufacturing capabilities.

That way, whichever vaccines do become available can be obtained more easily (and cheaply), facilitating booster shots or other specific vaccines as required.

This extends the work of vaccine deployment across all levels of government; whether that’s through subsidies for local businesses, the deployment of 150 respiratory (and soon to be immunisation) clinics by the Commonwealth, or the state and territory administered national immunisation program.

Federal Health Minister Greg Hunt says everyone who wants a vaccination will get one in 2021. -(AAP)

Work on building local capability has already begun, as Health Minister Greg Hunt revealed in an interview with the Herald Sun on Sunday, saying CSL will start manufacturing the Oxford AstraZeneca vaccine before the end of November.

Hunt said a priority list for the vaccine, which is yet to receive cabinet approval, would see first doses be made available to healthcare workers and the elderly, before opening up to essential workers.

“The expectation is that everybody who sought vaccination would be vaccinated well within 2021,” Hunt said.

States and territories are due to discuss, and potentially sign off on the federal government’s plan at a meeting scheduled for November, 13, and if all proceeds as planned the jabbing is slated to begin next March.

Australia’s efforts in developing a vaccine will also assist global efforts in deploying doses to inoculate countries with lower sovereign capabilities, particularly throughout the Pacific.

The Department of Foreign Affairs and Trade (DFAT) is already working with the multilateral Coaliation for Epidemic Preparedness Innovations (CEPI) on a COVID-19 vaccine global access facility, in what the government has previously described as a recognition that regional economic prosperity is tied to a multi-national success in vaccination deployment.

“Supporting our regional neighbors’ access will progress health outcomes, and help open up movement of people and goods, providing for economic recovery and longer-term resilience of the Pacific and South East Asia,” the government’s vaccine plan said.

Over the weekend Hunt and Foreign Minister Marise Payne announced a $500 million commitment to help eradicate COVID-19 across Southeast Asia and the Pacific.

While there are still no concrete commitments on how many vaccine doses Australia will supply to regional allies, these efforts will be buoyed or stymied by Australia’s success in deploying and manufacturing vaccines domestically.

That means the next 12-months will be crucial in determining what the medium term future looks like, not just for Australia, but for international movement and cross-border commerce more broadly.

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