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What we can learn from our COVID-19 vaccine distribution experience

By the end of March 2021, just 600,000 Australians had received their first dose of a COVID-19 vaccine – well below the Department of Health’s publicised target of four million. 

At the time, media outlets blamed the federal government’s domestic distribution and vaccine-administration strategies for the delay. Some focused their criticism on the use of private contractors, while others called for a re-think of the entire plan. But the Morrison government and Health said the issue was with supply, not distribution, and proceeded with Operation Covid Shield as originally drafted.

One year later, more than 93% of all Australians aged 12 and over have been double-jabbed, and almost half have received a third ‘booster’ shot. 

Given the slow start and the ongoing logistical challenges that the architects of the rollout faced, it’s arguably an impressive result – one the Department of Health says would not have been achieved without assistance from a range of public and private stakeholders. 

“Multiple cohorts are working together, including state hubs, GPs, GPRCs [GP-led Respiratory Clinics], ACCHOs [Aboriginal Community Controlled Health Organisations] and community pharmacies, as well as the aged care and disability sectors,” says a spokesperson for Operation Covid Shield says.

The department points out that more than 31 million of the 52 million jabs so far have been administered by GPs and pharmacies, underscoring how many healthcare stakeholders are taking part in the rollout. 

Large private firms remain heavily involved, too. Since the rollout began, logistics companies DHL and Linfox have not only been transporting vaccines to Australia from overseas manufacturing points but have also been delivering them to the various points of administration. The government supplied low and ultra-low vaccine freezers to the contractors to ensure safe domestic delivery of the vaccines.  

The Department of Health says the “significant challenge” posed by Australia’s vast geographic spread could not have been overcome if it hadn’t collaborated with private logistics providers. “As an example, linking in with the Royal Flying Doctor Service provided access to regional and remote communities for both delivery and administration of vaccines,” it notes.

According to University of Sydney epidemiologist and global-health researcher Meru Sheel, this sort of cross-sector collaboration has proven effective in various international jurisdictions since the pandemic began. “A pandemic response needs to be a whole-of-society response,” she says. “Multiple sectors, including NGOs, need to have input into health decisions.”

However, Australian Nursing and Midwifery Federation (ANMF) federal secretary Annie Butler says Australia’s reliance on private contractors may have contributed to delivery confusion and vaccine spoilage in the early stages of the rollout. “Our members would turn up at an aged-care facility to run a vaccine clinic and the vaccines wouldn’t turn up,” she says. “Or the vaccine would turn up but there’d be no vaccinators. In the beginning, we heard stories like that over and over and over.”

Butler says it’s unclear exactly what caused these problems but believes coordination was insufficient at a federal level. “They acted with a great deal of hubris, thinking they were on top of everything,” she says.

Vaccine ordering system

The Department of Health spokesperson declined to explain how interactions between stakeholders were managed in the early phases of the rollout but says the custom-developed COVID-19 Vaccine Ordering System (CVAS), which doubles as an inventory-management tool, gave the department full visibility. “CVAS gives [administration] sites a tool for ordering and stock management, which has improved access to vaccines and minimised wastage,” the spokesperson says.

The CVAS platform consolidates data from various existing systems and resources to create a central source of information about every vaccine vial in Australia. “It can track the location of vaccine stock at any time, from receipt from the manufacturer and sites placing orders to acceptance of deliveries and post-vaccination monitoring,” the DOH says.

The department concedes some deliveries within Australia were delayed, attributing the slow-downs to natural weather events, including flooding and bushfires. 

Nevertheless, the overall speed of our domestic rollout compares favourably with rollouts in other nations, according to associate professor Sheel. “The acceleration that took place at the state and territory level, particularly in response to the Delta outbreak [in mid-2021], was quite phenomenal,” she says. 

The efficient deployment of pop-up vaccine clinics by state-level stakeholders was a major boost to the effort, she adds.

Butler believes the underlying cause of the problems that nursing and aged-care members have reported to her is a lack of engagement between Operation Covid Shield’s central command, private distribution contractors and frontline workers. That lack of engagement contributed to the recent Omicron crisis in aged care facilities, she says.

“Collaboration back along the supply chain isn’t enough,” Butler says. “Providers and frontline workers need to be included in the conversation, too.”

The ANMF is calling for a national aged care Covid coordination centre, run by state and territory governments in partnership with aged care providers and unions, to improve outcomes in future. “Bringing everybody together in the same discussion is the only way to deal with what’s ahead,” she says.

Sheel echoes that sentiment, adding that a strictly ‘top down’ approach is too simplistic for a complex public health challenge such as universal vaccination. “When we discuss how these things should be managed, we try to avoid the term ‘control’ and instead talk about coordination and collaboration,” she says. “That’s because information sharing is really important in situations such as these. Things might need to happen in silos but understanding what’s going on in each other’s silos is really important.”

Her advice? “Do not underestimate the importance of collaboration.”

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