Terry Slevin – PHAA
“The Therapeutic Goods Administration (TGA) has approved booster doses of the Pfizer vaccine for people aged 18 years and older, six months after their second dose.
“In high-income countries, over 60% of people have had at least one vaccine dose, compared to around 4% in low- income countries.”
“Despite production forecasts of up to 12 billion doses being produced by the end of 2021, 92 low- and middle- income countries representing half of the global population – will have access to just 1.2 billion doses”
These three statements do not sit comfortably together. Can we explore how we might contribute to resolving the COVID-19 pandemic with countries in greatest need of help?
Don’t have time to read this? Watch Dr Mike Ryan from WHO explain it in 57 seconds.
Australia’s roll out
While there is still work to be done, the vaccination program in Australia has undoubtedly been successful, with more than 86% of us over 16 years old having had at least one dose. More effort is needed in various populations, including jurisdictions where there has been minimal COVID-19 outbreaks, and some Aboriginal and Torres Strait Islander communities.
In some cases, like the ACT, NSW and Victoria, single doses have going into more than 9 out of ten adults’ arms. Australia has among the highest vaccination rates in teenagers in the world.
Spreading our wings
For half the country, borders, offices, cafes and restaurants, and even airports are reopening and a sense of relief and optimism for a “normal” Christmas is palpable. These are wonderful developments to be applauded and celebrated. People in the public health world have a lot to be proud of and an enormous amount of virus-caused disease and death has been prevented. Many, many people have worked tirelessly to get us to this point, while reminding us that “this thing ain’t over”. As we drop our guard, see more people, travel more, gather in larger crowds, so too will more of the virus spread. But in a well-vaccinated population there will be far less illness and death.
But what about overseas travel? Us getting on planes, visitors arriving in Australia? What then?
Who’s for a boost?
We’ve more recently turned our attention to the issue of booster doses of the vaccine. There is lots of discussion to be had.
On Wednesday 27 October the Therapeutic Goods Administration (TGA) has approved the use of the Pfizer vaccine (COMIRNATY), and now awaits the Australian Technical Advisory Group on Immunisation (ATAGI) assessment of the evidence on risks and benefits of commencing a booster program. The government seems to believe the ATAGI recommendation is a foregone conclusion with booster roll out commencing “no later” than 8 November.
As of 7 October ATAGI has recommended a 3rd dose of COVID-19 vaccine as part of the primary course in individuals who are severely immunocompromised.
First (and 2nd) doses come first
Let’s lock one simple principle in. Be it domestically or internationally, first and second doses are the most vital first line of defence in responding to the pandemic. Be it in lower vaccinated states like WA, SA, Queensland and Northern Territory where reaching the large bulk of the community remains the highest priority. Even more so for Aboriginal and Torres Strait islander communities or communities with poor access to health care. But that is also very much the case for the rest of the world, and in particular low- and middle- income countries where health systems do not have the capacity to manage major outbreaks.
And remembering that COVID-19 is now a part of our world and will reach all parts of it – in time.
Vaccines supplies – how much is enough ?
The Australian Government has purchased or ordered a total of 255.8 million doses direct from manufacturers, including those ordered for booster shots in 2022/23. Excluding the dose swap/sharing arrangements with Singapore and the UK, we will have 126 million Pfizer, 25 million Moderna, 53.8 million AstraZeneca and 51 million Novavax COVID-19 vaccine doses. In addition to this, the Australian Government has pre-purchased 25 million doses for Australians through COVAX (of which it has already received 500,000).
About 13% of our population of around 25 million are under the age of 10, meaning we’ll be looking to vaccinate about 21.75 million people. If we vaccinate 100% of us, with three doses (allowing one booster each) that comes to a total of 65.25 million doses. Allowing for 10% wastage level (expiry dates being reached before they are used, that takes our needs to 71.77 million doses. Even if we allow two booster doses each (and no one is recommending that – still lots of evidence to be gathered before that could be considered) it still takes out maximum possible use to less than 100 million doses.
Even without our COVAX doses, we now have two to three times the supply than we could possibly need up to the end of 2022.
“56 countries who were effectively excluded from the global vaccine marketplace were not able to reach the target of vaccinating 10% of their populations by the end of September and most of them in Africa. Even more countries are at risk of missing the 40% target by the end of this year”.
World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus 13 Oct 2021.
Among some of our own neighbours, things are dire. Vaccination rates (including those only single dosed) in Papua New Guinea are less than 2%, Solomon Islands 17%, Myanmar 20%, Philippines, 25%, Timor Leste 39%, Indonesia 41%, Kiribati, 44%, and Tonga 47%.
Two fundamental problems exist. The first is supply and access to the vaccine. The second is the capacity and infrastructure to administer the vaccine program. Australia is contributing on both counts.
In terms of the rich versus poor reach of vaccines the graph below tells the story
So what are we doing to help ?
The Australian Government has invested over $8 billion in our own national COVID-19 vaccine rollout. We have also invested over $350 million in vaccine research and development.
On the international front, the Australian Government has joined the COVAX Facility as part of a global effort to support rapid, fair and equitable access to COVID-19 vaccines. COVAX is a collaboration between CEPI, Gavi, the Vaccine Alliance, and the World Health Organization (WHO) with UNICEF. Being part of it enables us to buy vaccine doses for ourselves via the COVAX Facility as they become available. We are part of the more wealthy 90 nations who put money on the table via COVAX.
A further 92 lower-income countries are eligible for support from it. Australia’s participation means COVAX can invest in different vaccines and support vaccine manufacturers.
So far Australia has committee $130 Million to the Advance Market Commitment of COVAX, with a focus on Pacific Island and South East Asian nations.
In addition, $623 million over three years is committed for the Regional Vaccine Access and Health Security Initiative – which is assisting our Pacific and Southeast Asian neighbours to access and administer safe and effective COVID-19 vaccines. This includes $100 million for our Quad partnership with Japan, the US and India to deliver a billion doses to Southeast Asia by the end of 2022.
These commitments may well be influenced by local geopolitics and the desire to prevent China being seen as the benevolent friendly neighbour who may wish to wield political influence in the future. Some might suggest Australia may want to throw its own noise party in the region and seek forgiveness from the neighbours… or other favours perhaps.
Perhaps the motivations are less important than meeting the immediate need.
The need to vaccinate the world is getting now urgent. As the virus spreads, particularly into new populations, there are increased risks of more mutations. And maybe worse than the Delta variant current running rampant. Apart from being the right thing to do, it is also in our interests to accelerate the rate of vaccination of the rest of the world.
How about one for one?
What about the idea that Australia commit to a “one for one” policy.
For every booster dose that Australia plans to administer, we commit to making one dose available for another country. And not just those who we wish to influence – but through COVAX mechanism which goes to those most in need.
So if we are suggesting one (and maybe 2) booster doses, committing to ensure we provide 20, (or 40) million doses to people without our resources and capacity?
Such a policy is easy to understand, is in our own interest and will boost our commitment to see the rest of the word come out of the pandemic more quickly that we might if we leave market forces to dominate.
So, the message is
- Keep going at home and
- One for one for our mates, as defined by – the rest of the world.
Looks like a pretty good foreign policy to us.
Adj. Prof. Terry Slevin, Chief Executive Officer, Public Health Association of Australia
This article was jointly published by Pearls and Irritations, John Menadue’s Public Policy Journal