Dismantling Fortress Australia

We wiped out community spread and bought a bunch of vaccines… now what?

There’s been a lot of talk over recent months about the failures of the Australian Government to respond to the COVID-19 pandemic, from their abortive, clumsy, most-eggs-in-one-basket approach to vaccine supply, to a so-obviously-racist-even-Andrew-Bolt-noticed decision to lock out Australians trying to return home from India, to a complete lack of vision or willingness to outline a plan for how we even begin to reopen Australia to the world.

There is plenty to criticise the Commonwealth Government for, but in light of their flawless track record of incompetence in every area for which they are responsible, it would be better for everyone’s sanity not to expect anything different of them in the future. Assuming they continue to be deeply incompetent forever — they’re already starting to campaign for the next election, but don’t expect them to get any better as a result — what’s next for Australia? And what is next for you, personally, if you happen to live in Australia?

First of all, we can expect more of the same in regard to pandemic management, which is to say that it will be almost entirely down to the states. Just ignore anything the Prime Minister and federal Health Minister have to say — it’s irrelevant, and you’ll just get confused and/or upset if you listen to them. The Federal government will continue to mishandle vaccine ordering, supply and (crucially) messaging, and the states will increasingly have to go it alone on distributing, administering and promoting those vaccines, as well as continuing to manage everything to do with quarantine of international arrivals and dealing with the inevitable outbreaks of community transmission. I’d therefore expect something like the following over the coming months:

• ample supply of the AstraZeneca viral vector vaccine — we already produce more than one million doses of that vaccine per week, right here in Australia
• limited supply of the Pfizer mRNA vaccine — this can only be obtained from US-based manufacture, the process for which is so secret they haven’t even patented critical parts of it (because other people could see what’s in a patent application)
• no other SARS-CoV-2 vaccine availability within Australia, despite recent announcements of orders of the Moderna mRNA vaccine
• the Federal Government maintaining its “1a, 1b, 2a, 2b, 3” set of priorities for vaccination as if it’s some sacred order, and simultaneously failing to deliver vaccines to priority groups in Federal areas of responsibility
• states increasingly disregarding those priority groups in favour of getting vaccines into anyone who will show up
• many of those who are eligible to be vaccinated choosing not to get vaccinated despite having the opportunity

In light of all of the above, it wouldn’t surprise me if only a minority of Australians are even partially vaccinated by the end of this year.

This seems like a good juncture to talk about the vaccines themselves, because there is a lot of destructive misinformation floating around, and I’d like to do what I can to clean some of that up. I will only talk about the vaccines currently available in Australia: the Pfizer/BioNTech mRNA vaccine, and the Oxford/AstraZeneca viral vector vaccine.

While the technology underpinning these vaccines is quite different, these vaccines have a lot in common:

• they are both highly effective in preventing symptomatic COVID-19
• they are both virtually 100% effective at preventing severe disease (i.e. hospitalisation and/or death)
• while there is evidence to suggest lower effectiveness in preventing symptomatic COVID-19 caused by certain variants, available evidence still suggests that both vaccines remain highly effective at preventing severe disease caused by those variants.
• neither vaccine completely prevents infection, therefore if someone is vaccinated they have a reduced but still significant risk of forming part of a chain of transmission. Those who are unable or unwilling to be vaccinated will depend on both an extremely high level of vaccination in the surrounding population and access to top-quality treatment if and when outbreaks occur.
• there is no evidence to suggest that having one vaccine reduces the effectiveness of another vaccine administered at a later date.

Unfortunately, a lot of people reading the above will already be distracted by the elephant in the room… by which I mean the minuscule speck of dust that happened to land so close to a light source that the shadow it casts really looks like an elephant. I am, of course, referring to the presumed (but not yet proven) link between the AstraZeneca vaccine and a particular extraordinarily rare blood clotting syndrome referred to as thrombosis with thrombocytopenia syndrome (TTS). When I say “extraordinarily rare”, I mean “so rare that our brains are absolutely terrible at responding appropriately to the associated risk” (as I described in my previous story).

If I told you that — in order to protect yourself and potentially millions of fellow Australians from a debilitating and life-threatening contagious disease — you need to continue to engage in your routine travel on the roads for the next two weeks (instead of completely avoiding road travel during that same period)… you wouldn’t hesitate, would you? You wouldn’t suddenly say, “wait a moment — I’m not taking a risk like that! And certainly not for the health and safety of me and my family!” But just two weeks of an average amount of travel on Australia’s roads is more likely to kill you than any complication of the AstraZeneca vaccine, even assuming that the link between AZ and TTS is, in fact, causal.

But it’s even more extreme than that — based on the data available so far, the incidence of TTS is almost entirely confined to younger people (especially younger women), so the risk if you are not a younger woman might as well be zero, even if you are a person who considers the risk of travel on the roads to be so great as to avoid it for weeks at a time for that reason.

All of the above leads to a few conclusions as to what you, as an individual living in Australia in 2021, should aim for with regard to vaccines:

• get vaccinated as soon as a vaccine is available to you, and keep your ear to the ground as to where and when that might be — Federal-level messaging on this is non-existent, and plenty of state-level communication also leaves a lot to be desired.
• if you are already 50 or older living in any state of Australia, you are eligible for a vaccine right now and — as I said above — you should get it as soon as you can. In most cases, this will be the AstraZeneca vaccine, which is both highly effective and extremely safe.
• some states are already offering vaccines to people under 50 who do not meet the criteria for inclusion in the higher priority groups… because those who do meet those criteria aren’t presenting for vaccination, and the states might as well vaccinate the people who do show up. NSW are doing this in a highly organised and official fashion, while Victoria is doing so on a more ad-hoc basis (this has a lot to do with the ongoing differences between the respective state health departments).
• even if you believe an mRNA vaccine will provide better protection in the long run, there is nothing at all to stop you getting the AZ vaccine now and also getting a Pfizer or Moderna vaccine or booster some time in the future.
• if you are a younger adult, particularly a younger woman, the official guidance is that you should get the Pfizer vaccine. You can already do so if you are aged 40 to 49, live in NSW and are able to get to one of the mass vaccination centres. I expect Victoria will shortly follow suit. If you are aged under 40, you will likely have to wait several more months.

There has been a lot to complicate the issue here: those who think Scott Morrison is a selfish prick (which he absolutely is) believe that he selfishly got himself a better prick than he’s making available to others. This neglects the facts: Scott Morrison (being both a narcissist and an idiot) believed that he would inspire Australians to get vaccinated if he went and did it first. Of course that isn’t true — even most of those who vote for the Liberal Party don’t believe that what Scott Morrison does is a good indicator of what anyone else should do. But that’s beside the point: when Scott made such a vacuous spectacle of getting himself vaccinated, the only vaccine that was approved for use in Australia was the Pfizer vaccine. The AstraZeneca vaccine was still awaiting approval. But the AstraZeneca vaccine has now been approved for use in Australia. Brett Sutton (the Victorian Chief Health Officer) got his first dose of the AstraZeneca vaccine a few weeks ago. Anyone insisting that Scott got a “better” vaccine because he could, really needs to ask themselves whether they’d rather follow in the footsteps of Scott Morrison or Brett Sutton when it comes to health care choices.

Be honest: which of these men are you going to follow for health care guidance?

Then there’s the fact that the Pfizer vaccine is more expensive… and more expensive equals better! If you think that is a sound argument, allow me to introduce you to the pharmaceutical industry. The Pfizer vaccine is more expensive because they are keeping an iron grip on supply — which they can do because of the aforementioned control of the manufacturing process — and raking in astronomical profits. In contrast, the AstraZeneca vaccine is vastly cheaper because it has been widely licensed for production (including right here in Australia), as well as not requiring the same degree of deep-cold storage. They’ll still be doing very-nicely-thank-you-very-much out of the licensing deals (since that means they don’t have to shoulder the costs of producing hundreds of millions or billions of doses). While overall demand for the vaccines so greatly exceeds supply, they can all charge pretty much whatever they like, but the broader production base and licensing of the AstraZeneca vaccine, along with easier handling, greatly reduces the price.

So that’s a not-so-brief (but hopefully somewhat helpful?) outline of where we stand in Australia in regard to vaccine availability.

For now, many people in Australia cannot get vaccinated even if they want to. Many that are supposed to have been vaccinated already, haven’t been. I suspect there’s a considerable number of those who could already get vaccinated who are so far choosing not to do so, because there is no pressure on them individually: being vaccinated doesn’t currently grant one any greater freedom than not being vaccinated, and without any significant spread of SARS-CoV-2 in Australia outside of hotel quarantine, individuals in Australia quite correctly calculate their personal risk of infection as extremely low, with or without a vaccine. But that picture is going to change gradually over the coming months, even if we avoid major outbreaks like the one currently hitting Taiwan. Here are a few predictions on how that will change:

1. Supply and availability of vaccines will increase over the coming months, to the point that the sole determinant of whether or not you have received a vaccine is “have you chosen to get a vaccine?” — vaccines will be available, for free, to every adult in Australia, eventually extending to every person aged 12 or over (as is currently the approval for the Pfizer vaccine in the USA).
2. Even when we reach that point, there will still be enough people refusing to be vaccinated, that any reintroduction of the virus to the community will result in outbreaks severe enough to trigger new lockdowns and restrictions on interstate travel (with the probable exception of NSW, who are likely both to get better vaccination levels and maintain better contact tracing than any other state, due to the strength and effective outreach of their state health department).
3. Governments — both state and Federal — will then face the unenviable choice of whether to maintain “COVID-zero” policies of lockdowns and border closures, or to offer greater freedom (such as international travel for Australians without a requirement for hotel quarantine on return — possibly with a requirement to quarantine at home instead) to those who have been fully vaccinated, or to offer greater freedom to everyone including those who have not been vaccinated, on the basis that at least everyone could be vaccinated if they wanted to and therefore that risking severe disease is now a personal choice.

I rather doubt that we will see the last scenario play out, if only because it would be political suicide when contrasted with the actions and successes of the last 14 months. However, there seems to be a point beyond which it would also not be politically tenable to hold the line that “everyone who wishes to be vaccinated can now be vaccinated, but you all still have to give up international travel forever because too many people are choosing not to be vaccinated”. Therefore, I think the middle option is most likely: a progressive relaxation of restrictions on anyone who has been vaccinated, but only once we reach the point of universal vaccine availability.

After that, it seems fairly obvious what the next step in the evolution will be: the individual calculus for vaccine refusers will change — no longer will it cost you nothing to continue to refuse to be vaccinated, instead it will cost you individual freedoms that others now enjoy (such as international travel, and/or the removal of a requirement to pay for hotel quarantine on your return). The background risk of being exposed to SARS-CoV-2 within Australia will no longer be effectively zero, so the choice of being unvaccinated will also carry a small but significant risk of developing severe or life-threatening disease if you are exposed to the virus. Workplaces that involve contact with people may also move towards requiring proof of vaccination from their employees to permit them to attend work.

All of these changes will lead to increasing isolation (social and/or political and/or economic) of those who continue to refuse to be vaccinated, such that many of those who are currently vocal about not wanting to be vaccinated will quietly go and get it done, whether in order to join their mates on the next trip to Bali, or because they’re afraid of ending up in hospital if they do catch it in the next outbreak, or just because they want to keep their job.

That will mark the end of the “Fortress Australia” policy. The time frame in which that occurs will depend on political calculations around such things as the electoral backlash from older Australians (who resent being given what they incorrectly believe to be a substandard vaccine), profit interests of major political donors (who very much resent having their profits adversely affected by such things as concern for human life), and delivery time frames for mRNA vaccines compared to constitutional requirements around the timing of our next Federal election (which is due within 12 months).

Having earned ourselves a great deal of domestic freedom through our collective sacrifices in 2020, the year ahead looks set to be both more tolerable and more frustrating, as the square-wheeled rollout of vaccination promises and — eventually — delivers what we will adapt to as our post-pandemic life.