Former health secretary Stephen Duckett has spoken to The Mandarin about how governments at all levels have responded during this extraordinary time in history, and lists some of the key bureaucratic challenges holding the commonwealth government back.
From overnight border closures, quarantine quibbles and a vaccine rollout that stumbled at the starting gate — the toll of COVID-19 has been serious and widely felt. So why, during a global pandemic, has Australia’s government response felt so bungled, and how long will it take before we reach herd immunity?
Jabs, jobs and leadership gestures
The government declared this week that Australia’s emergency response to the COVID-19 virus was over (in the same week it clamped down on all returning flights from India until mid-May), saying it was now time to transition to the ‘path of economic recovery’. The announcement landed a few days shy of the federal budget.
By Sunday, more than 2 million COVID-19 vaccines had been administered nationwide (about half of the federal government’s March target), with 36% of those administered in state and territory clinics. Across Victoria’s 21 vaccination hubs, optimistic scenes of citizens (mostly 50+) lining up to roll back their sleeves and get a shot made the nightly news. Sydney’s mass vaccination hubs are due to start operating next week.
This daily infographic provides the total number of vaccine doses administered in Australia as of 4 May 2021. Stay up to date with COVID-19 vaccine information here: https://t.co/TUKfzVuGVm #COVID19vaccines #COVID19 pic.twitter.com/YtHiQJbma4
— Australian Government Department of Health (@healthgovau) May 5, 2021
Behind these positive scenes of public health response and getting the job done has been months of warring words between state premiers and the feds, thinly-veiled blame games and the hasty announcement of a vaccine program that has faltered for reasons both within and out of the control of the commonwealth (Do we have enough doses? Is Australia totally reliant on vaccines sourced from overseas? What is the timeline for fully vaccinating most Australians?) — but all foreseeable.
Then there was the rapid move to halt flights from India and impose a temporary ban on Australian citizens from returning home from the COVID-ravaged nation (with a penalty of up to $60,000). On Wednesday, an Australian stranded in Bangalore decided to challenge the government’s travel ban decision in the Federal Court.
The whole narrative of Australia’s response to COVID-19 has been driven by good or bad headlines, rather forgetting how complex and logistically mammoth the undertaking might be. But the news of missed targets and lapsed deadlines is also a bright line for the Australian voter to measure basic government competence against.
Contracts, consultants and suppressing the curve
According to Professor Stephen Duckett, former federal secretary at the department of health, a lot of the ‘over-hyped and under-delivered’ failures of the COVID-19 vaccine rollout come down to staffing issues. He says that the operational challenges faced by federal departments is a legacy of decades of LNP and Labor governments stripping resources and expertise from the APS.
A staffing cap imposed by the Morrison government has also caused strain within Health, making a scaling-up of its capacity during the pandemic challenging.
“The staffing level caps in the Department of Health haven’t helped – and the government is responsible for those,” Professor Duckett says.
“So, come an emergency, it’s hard to flex-up because you do need some expertise.”
The resource shortfall within the Health department has played out most significantly in the contracts that the commonwealth has been able to negotiate for COVID-19 vaccines, he added.
To date, Australia has entered into four separate agreements with suppliers of different types of COVID-19 vaccine (worth more than $4 billion) should they prove to be safe and effective. The government has also stumped up $350 million to support vaccine research and development.
Duckett says being able to negotiate a fit-for-purpose contract is a sophisticated skill. In a skills-deficient environment however, more government money is given to consultants to deliver this expertise — but even consultants lack the fundamental operational understanding that state-based public servants bring to contractual negotiations.
“Writing a contract is actually quite a sophisticated skill, which you just can’t turn on and off, and even though the commonwealth doesn’t deliver anything, it has to be able to write contracts,” Duckett says.
“So the alternative strategy is to hire consultants, who also don’t have the understanding of the issues — they breeze in and breeze out. Today they’re working on health and tomorrow they’re working on transport, and the day after they’re working on wheat.”
Duckett, who currently serves as the Grattan Institute’s health program director, has held a number of senior healthcare leadership positions in a long and distinguished career. He served as the federal secretary at the department of health from 1994-1996, and he was also a leader in the VPS healthcare space throughout the ‘80s and ‘90s.
In his view, a combination of weak operational capacity and extremely risk averse bureaucrats, have contributed to some of the stumbles in Australia’s COVID-19 response. In part, he argues, this is a hangover from the Pink Batts scandal; but it also runs against a trend in health settings like hospitals to move quickly and with less certainty — because good outcomes depend on being adequately responsive.
On the other hand, he says, dealing with complex decisions is literally the brief of a department head.
“The secretary would be encouraged to be cautious — they would be crossing the Ts and dotting the Is very, very carefully,” Duckett says.
“[However], one of the jobs of any senior manager is to manage complexity — if there aren’t significant trade-offs, it shouldn’t actually come to the secretary’s desk. That’s just part of their job.”
Politicising a public health emergency response
In August of last year, Duckett saw a red flag when the federal government announced with fanfare that it had signed a letter of intent with AstraZeneca for the Oxford COVID-19 vaccine. Although the prime minister’s August press release included a few lines cautioning that the vaccine would be subject to trials and there was no guarantee of a silver bullet, the federal government continued to make announcements to give the impression of progress, only to fail to meet its self-imposed timelines.
One of the most embarrassing failures was declaring that by the end of March, 2021, at least 4 million Australians would be vaccinated. Total vaccinations in Australia were still shy of one million (by tens of thousands of shots) by April. Scott Morrison, on the defensive, argued that supply issues were to blame — but fundamentally, it was a failure in logistical planning that has drawn the ire of GPs, pharmacists and the states.
“There were unreasonable expectations,” Duckett says.
“Australia’s vaccination program is the biggest logistics exercise in the country’s history, and yet we don’t have in the Commonwealth department that sort of level of logistics expertise. So we set a whole lot of targets, which were unachievable.”
“The target-setting was in a sense a political exercise to say to the Australian people: ‘We’ve done fantastically, we’re going to get 2 million done’ — even after we knew there were problems in the international supply chain.”
According to Duckett, the political posturing, which implied that Australia was at the front of the vaccine queue and that the rollout would occur early and quickly, backfired.
While it was fair for Health to take the position that Australia had more time than most other nations to get the vaccine rollout right, the fact things have gone backwards in terms of timely supply and slow logistical progress does not make the need for vaccines any less pressing.
“I think the department is under a lot of pressure to get everything done quickly — to get the vaccine rollout done smoothly and quickly, because the government thinks it gets kudos from a fast rollout, and it’s true – but it doesn’t get kudos if it becomes a train wreck.”
“The problem is, Australia both delayed and got it wrong. We can’t have it both ways,” Duckett says.
It is also a problem that the federal government succumbed to the temptation of viewing the vaccine rollout as a political issue rather than a public health program, he says, because this impacted their vision and planning about what heavy-lifting GPs could do in dispensing shots.
Duckett wrote in a recent piece for The Conversation about the logistical ‘debacle’ that was getting vaccines delivered from warehouses to states or GPs. He said that for a period of time, neither the states nor GPs knew how many vaccines they were due from one week to the next , which made planning impossible.
He also admonishes the dismissal of Australia’s need for urgent vaccination with lines like ‘it’s a marathon, not a sprint’ as dangerous.
“In fact, it is a sprint and we have seen that the virus leaks out of hotel quarantine, it leaks out of health services – so there are risks of slow vaccine rollout and we’ve got to accept that and we’ve got to say that we’ve got to be getting it done and getting it done quickly.”
It has now been just over a year since the World Health Organisation declared the coronavirus (COVID-19) a global pandemic and in Australia there remain unresolved questions about our vaccination rollout, and state-based quarantine arrangements. Duckett suggests that the Health department needs to advise its minister about realistic targets and start working meaningfully with the states to get on with the rollout expeditiously.
“They need to be going to the states and saying ‘you’ve got the feet on the ground, can you start these vaccine hubs up? Can we do things differently? Can we have a cooperative approach?’,” Duckett says.
“The bureaucrats should be actually saying ‘we’re working together, we’re trying to do the best we can’ and the job of the politicians is not to make their job too difficult.”