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Scott Morrison is upping the ante on planning for the next stage of Australia’s vaccine rollout. He’s announced an urgent meeting of the national cabinet on Monday to discuss changes amid delays and the decision not to recommend the AstraZeneca vaccine for under-50s.
So as the prime minister and the leaders of states and territories put their heads together to iron out problems with the rollout, perhaps there are lessons to be learned from countries that have already achieved high rates of vaccination.
According to the New York Times global vaccine tracker, which uses data compiled by the University of Oxford, Australia ranks 81st, at 4.7 doses administered per 100 people. Analysis of the same data by Guardian Australia ranks Australia at 100.
Israel tops the charts with 115 doses administered per 100 people, which means many people have received their second dose and almost 60% of the population are fully vaccinated. In the US, more than one-fifth of the population was fully vaccinated as of 11 April.
So why have some countries been so fast and successful? How does Australia compare, and what methods could be adopted from other countries’ approaches?
Israel: efficient rollout but privacy compromised
Since Israel began its vaccine rollout in mid-December, more than half of its population have been fully vaccinated. The speed and efficiency has been attributed to low vaccine hesitancy and incentives such as a “green pass” app, which allows fully vaccinated people to enjoy more amenities and activities, such as going to restaurants or gyms.
But some researchers and epidemiologists, writing in the British Medical Journal, put the success down, in part, to a collaboration agreement with the drug company Pfizer, which is seeing the anonymised age, sex and demographic data of patients being handed over.
“Compared to the European Union, Israeli privacy and data protection laws allow for more latitude (and were last updated back in the 1990s),” the authors wrote. “The agreement has had the positive effect of helping Israel secure a large number of vaccine doses promptly, and most of the text of the agreement has been made publicly available as an effort to increase transparency. Yet questions remain about the levels of aggregated data that will be shared and how the data will be protected.”
Aditya Goenka, a professor of economics at the University of Birmingham in the UK, said in a piece for the Conversation: “Whether individual data should be shared with profit-making companies without explicit consent remains an important question, especially as information on 140,000 Covid patients has already been shared with Shin Bet, Israel’s security agency, without due approval and authorisation.”
Like in Australia, suitably trained nurses are authorised to administer vaccinations in Israel, which is helping to speed up the rollout. However, Israel’s nurse ratio is below the OECD average. There are questions about whether using an already scarce workforce to administer vaccines rapidly will have a detrimental effect on other parts of the health service where nurses are sorely needed.
Meanwhile, Palestinians in occupied territories are still struggling to get the vaccine.
Canada: prioritising Indigenous people and effective communication
As of 12 April, almost one in five Canadians had received at least one dose of a Covid vaccine. Almost 22 doses have been administered per 100 people, about five times higher than the rate in Australia.
According to Alexandra Martiniuk, a professor of epidemiology at the University of Sydney, Canada is a useful comparison country in terms of geographic distances and Indigenous population.
She said Canada went to extraordinary lengths to prioritise its First Nations populations, with everyone in all 31 fly-in-only remote Indigenous communities offered their first vaccination by 8 March. A handful of people flew by helicopter into these communities, delivering the vaccine in -35C temperatures.
“But it was really the community leaders on the ground who made it all happen by having community coordinators address local people’s vaccine hesitancy and arranged rosters of community members to organise and lead local vaccine clinics,” she said.
“Like [in] Australia, Canadian provinces are handling Covid vaccination implementation slightly differently. Many have said that Canada has even less centralised implementation than Australia. Canada does not have a national database for immunisation, which is a real problem for Canada, whereas Australia does have such a database.”
But Canada has provincial databases for health that cover the entire population because it has a single-payer system – a solely public system run by the government. “This may help Canada see signals, for example vaccine adverse effects, earlier than Australia, which has more diffuse data collection methods due to the mix of public and private systems, and multiple insurance players,” Martiniuk said.
Hassan Vally, a professor of epidemiology at La Trobe University in Victoria, said Australia could learn from good communication in countries like Canada.
“Although not all of the challenges we have faced have been avoidable, many of them could have been avoided with better coordination and communication,” he said. “Importantly, improving in this area is needed to build confidence in the community. Any confusion and disharmony erodes confidence in the vaccine rollout and this spills over into eroding confidence in the vaccine.”
UK: mass vaccination clinics are key
Despite being among the hardest-hit countries in terms of the impact of Covid-19 on health and the economy, the UK has now administered at least one vaccine dose to almost half of the population. The National Health Service has handled the bulk of the rollout since it began in December and some vaccination centres are open 24/7.
An analysis by the University of NSW in Sydney found dedicated large-scale vaccination sites capable of delivering thousands of doses a week are crucial if Australia is to boost the pace of its rollout, and that relying on GPs and pharmacies alone will not be enough.
The UK has made use of a network of 233 hospitals, 1,000 GP surgeries, 200 pharmacies and 50 mass vaccination centres. The national leadership was supported by the military, which helped source and distribute the vaccine.
“Local delivery drew on the assets of the NHS, local government, volunteers, community and faith leaders and others to ensure the safe and effective provision of vaccines,” UK health policy academic Chris Ham wrote in the British Medical Journal. “The private sector played a supporting role on data analytics, and delivery was enabled by access to a comprehensive patient database.”
In Australia, the federal government is also responsible for acquiring and delivering the vaccines to the states, but this has been marred by supply shortages and led to bickering between the states and the federal government.
Australian National University infectious diseases expert Prof Peter Collignon said while it was true mass vaccination clinics would be essential in Australia, the government has been criticised for saying the vaccine could have been delivered faster if these clinics were set up weeks ago.
“It was a load of garbage because the supply just wasn’t there,” Collignon said. “I mean, even GPs couldn’t get more than 50 doses a week. There has been a real disconnect between the real world and supply and people’s expectations.”
What about countries with low or no Covid like Australia?
Collingon prefers to compare the countries that have had good control and low transmission, which includes Australia, New Zealand and Taiwan. “We’re ahead per capita of both of those countries,” he said.
“New Zealand’s probably a couple months behind us. Then if you look at Japan and South Korea, which had good control of the virus until more recently, we’ve got more vaccines administered per capita than those as well. The only country I can think of that has actually got good control and more vaccine rollout than us is Singapore.”
However, Singapore, which benefits from being an island like Australia, has the added benefit of a small, contained population.
“There is a really limited supply of vaccine and despite this, rich countries are getting most of it, because they’re bidding up the prices and the pharmaceutical companies are trying to make as much money as they can, particularly Pfizer,” Collignon said. “I think we’ve got to be selfish enough to look after our most vulnerable, but beyond that, I find this whole comparative business somewhat disconcerting, because I think we need to be looking at the more vulnerable in the world a bit more.”
How do you define success?
It is important to note that some countries started their rollouts later for various reasons, and in Australia’s case, that was to make sure it had access to as much vaccine safety and efficacy data as possible before approving them.
Some countries do not update their rollout data daily, so comparisons can also be skewed for that reason. Vally believes comparisons with other countries in terms of vaccines delivered, “while interesting, are essentially meaningless”.
“It really is a case of comparing apples with oranges,” Vally said. “In many ways we are all playing a different game when it comes to vaccine rollouts, with different imperatives and different goalposts and obstacles. It’s an entirely different proposition to be delivering vaccine when you have no community transmission to rolling out the vaccine when you have uncontrolled transmission and are wanting to use the vaccine to bring transmission under control.”
Stuart Turville, an associate professor at the Kirby Institute’s immunovirology and pathogenesis program, is also uncomfortable with country rankings because they can fail to highlight that some countries are prioritising their own programs while neglecting their less wealthy neighbours.
“It’s a global disease,” Turville said. “You can be high on the vaccine rankings and then neglect your nearest neighbour. If that neighbour has an inordinate number of infections, then rare events occur, such as new viruses coming online. Variants P1 [discovered in Brazil] and B1351 [discovered in South Africa] were initially geographically isolated. Now they are sprinkled across the globe.
“There needs to be a bigger picture to tackle this. We cannot live in geographically bubbles indefinitely.”
Source: The Guardian
Keyword: Vaccine chart toppers: what Australia can learn from world’s best rollouts | Vaccines and immunisation