Crux of the matter
Delays and miscommunication dog the aged care worker vaccination rollout, with confusion over who was contracted by the Health department to do what.
The debate: How has the aged care workforce factored into Australia’s vaccination program?
In a February 16 joint press release, Minister for Health and Aged Care Greg Hunt and Minister for Senior Australians and Aged Care Services Richard Colbeck outlined the federal government’s vaccination program for aged care facilities. The program’s aim was to prioritise those ‘particularly vulnerable to the worst effects of the coronavirus’, within ‘approximately six weeks’.
“Vaccination for residents and staff will be made available through residential aged care facilities where they live or work, and it will be administered through an in-reach workforce provider,” Hunt said. “Healthcare Australia will be providing the vaccination workforce in New South Wales and Queensland, and Aspen Medical will be responsible for the other states and territories.”
Vaccination for home and community aged care recipients and staff would occur in the community, while the New South Wales, Victorian and the South Australian governments would maintain responsibility for vaccinating residents and staff of the public sector residential aged care and disability care facilities.
Colbeck said the federal government would be responsible for leading the program’s implementation in the aged care sector, and added that the government is “consulting with relevant peak bodies and state and territory governments, but the responsibilities are clearly delineated so all parties understand their role in this critical and complex program.”
However, according to a national survey quoted in Senate estimates June 1, the Health department revealed that a minimum of 32,833 aged care workers — or less than 10% of roughly 366,000 in Australia — had received both doses. For comparison, secretary of the Victorian Department of Health Euan Wallace told The Age on May 31 that roughly 90% of aged care staff at state-run facilities had been vaccinated, and all state facilities had been visited for first vaccination doses over March and April 2021.
The federal department admitted it did not have the full figure, but said a reporting tool would shortly go live at the My Aged Care portal, where, from June 15, providers will be required to issue weekly reports detailing their total number of workers, the number with their first dose and the number with both doses.
Colbeck revealed the department had received health advice that it should not vaccinate the workforce and residents together, on the basis of overseas experiences and to minimise a crossover of adverse reactions, and the in-reach program would therefore prioritise residents.
Aged care workers could find alternative avenues (GP clinics, pop-up clinics and state-run inoculation mass hubs) or, per the federal vaccine dose policy, receive spare doses where available after residents have been vaccinated; a department spokesperson tells Mandarin Premium that, as of June 12, more than 83,670 spare doses have been administered in this way.
Further changes were implemented based on advice on April 8 from the Australian Technical Advisory Group on Immunisation recommending Pfizer for people aged under 50 years and AstraZeneca for people aged 50 years and over.
On April 9, the Health Department issued communications to all residential aged care facilities, as well as to the broader aged care sector, to advise the rollout to residents would continue as planned and the workforce rollout would be reviewed as part of the recalibration of the national vaccine program. A spokesperson explains that:
Residential aged care workers aged under 50 have been able to access a Pfizer COVID-19 vaccine through a range of options including Commonwealth vaccination clinics, state and territory vaccination clinics, general practices, Aboriginal and Torres Strait Islander Community Controlled Health Services and where available dedicated aged care and disability worker vaccination clinics.
Workers 50 years and over are able to access an AstraZeneca COVID-19 vaccine at a GP clinic, GP respiratory clinic or Aboriginal Community Controlled Health Service, GP in-reach vaccination clinics at their facility or state and territory AstraZeneca COVID-19 vaccine clinic.
The Department has issued communications to all residential aged care facilities, peaks and unions advising of the recalibrated national program, including updated factsheets (translated in 19 languages) for facilities to distribute to all workers advising how they can access a COVID-19 vaccine.
The Commonwealth is working with States and Territories to activate more Pfizer access points and this will be communicated as they become available.
Amid Melbourne’s most recent COVID-19 outbreak, the Victorian government residential disability and private aged care staff would receive priority access at walk-in vaccination hubs as part of a blitz from Wednesday, June 2 to Sunday, June 6.
A day later, the Queensland government would announce a similar plan for aged care and disability workers, with Health minister Yvette D’Ath taking a veiled dig at the federal rollout: “We can’t wait any longer. I want all of our residential aged care and disability workers vaccinated urgently.”
A question of contracts
Notably, estimates also revealed that Sonic Healthcare and International SOS were also revealed as having shared in $76 million worth of contracts for the federal program, while both Healthcare Australia and Aspen Medical were responsible for Victoria’s rollout. The department has not specified how else original responsibilities — New South Wales and Queensland for Healthcare, rest of Australia for Aspen — has changed.
The Age reported on Wednesday, June 2 that an Aspen Medical spokesman said the company had only ever been contracted to immunise aged care residents, not staff; however, the company shortly clarified in a June 5 Guardian Australia report that the provider “has vaccination of aged care staff as part of its contractual obligations, and in that context has already vaccinated over 20,000 staff.”
Likewise, Healthcare Australia initially told the publication it was “contracted to provide vaccinations for aged care residents only”, but subsequently issued another clarification that it was “contracted to provide vaccinations to both the aged care residents and the workforce but was instructed by the department to prioritise the residents”.
Conversely, Sonic Clinical Services told the Guardian it was not contracted to do staff vaccinations, and has not responded to an updated request for comment from Mandarin Premium.
“We have not been contracted to provide in-reach vaccination services to Residential Age Care staff in Victoria (or elsewhere) and have not been involved in a tender process to do so,” said chief executive Dr Ged Foley.
International SOS would only refer questions to the Department of Health, which has clarified that all four companies were “contracted to provide targeted and flexible vaccine administration support to ensure timely and safe access to COVID-19 vaccines for residents and workers across residential aged care facilities in scope for the Commonwealth’s vaccine program.”
While no parties have publicly explained how the two providers contracted to rollout vaccines in Victoria initially claimed they were not responsible for staff, Mandarin Premium understands that a federal work order prioritising residents, and issued around the start of the February 21 rollout, led to some equation of what has become standard practice vs what companies were technically contracted do to.
Last, it is worth noting the department has engaged 50 mobile teams in Victoria to vaccinate workers and residents in priority locations, and separately issued a Request for Tender (RFT) for residential aged care providers to vaccinate their own workers, which the department says come in response to “advice from the sector that many providers had existing capacity to vaccinate their own staff and would like to do so.”
Closing on July 30 — a full five months after Hunt and Colbeck’s initial press release — the RFT “recognises the known capability and capacity within many residential aged care facilities to conduct safe and efficient vaccination programs.”
Voices of experience: How else could the program have been run?
On June 8, the Australian Nursing and Midwifery Federation (Victorian Branch) issued a call for Colbeck to resign “after he admitted he did not know how many aged care staff had been offered COVID-19 vaccination through the Commonwealth program but was ‘comfortable’ with the roll-out”.
Citing both The Age and Guardian Australia’s news reports, the branch also called on the Morrison government to reveal whether the private aged care workforce was included in contracts between the government and private companies rolling out the Commonwealth’s aged care vaccination program.
“Was it only ever a vaccine-dregs-for-staff arrangement?”, ANMF (Vic Branch) Secretary Lisa Fitzpatrick said, arguing responsibility for vaccinating the aged care workforce should have been given to the states months ago. “Don’t blame staff for not being vaccinated when you never told them you had no intention to vaccinate them at their workplace.”
“The royal commission revealed the private aged care system was in crisis before the pandemic, Australia needs an aged care minister who will never be comfortable until residents and staff are properly protected from COVID-19. We’re calling on Senator Colbeck to resign. We need a minister who gets things done with a sense of urgency, care and respect for the residents and the dedicated staff.”
However, a source closer to the providers’ end argues they never got the impression the in-reach program would cover staff, and that, historically-speaking, certain logistical challenges — i.e., multiple trips required per home, staff schedules — have meant it has been simpler for staff to obtain their own flu vaccines. One problem, they note, has been a lack of clarity from the federal government as to where staff should go for their vaccines.
There is also the proposal to make the vaccine mandatory for staff, which the federal, state and territory governments issued in-principle support for on Friday June 4. Four days later, Western Australia announced it would be the first state to make the jab mandatory for workers, with the requirement set to come into effect from August.
Finally, aged care policy expert and Honorary Professor in the Department of Sociology at Macquarie University Anna Howe cites colleagues from Victoria telling her “it has been a very expensive shambles with some providers being told they can provide vaccinations to their staff and others told they cannot.”
“It would have been a very efficient strategy to have at least large providers do clinics for their staff, including community care staff when they deliver community care as well,” Howe says. “Among the advantages are that staff would know the nurses (who as they can give all kinds of jabs could presumably give COVID jabs) and would presumably trust them; very convenient for staff; easier to know about and monitor any side effects; and foster a team spirit, all things that put together are likely to increase take up well above leaving it to the individual.
“And much less costly. There have been problems with logistics and getting doses to where they are needed, but not insurmountable.”
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