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In volatile times, the COVID-19 wrap provides an evidence-informed update

Introduction by Croakey: In Europe, the World Health Organization (WHO) has warned that another 500,000 people could die of COVID-19 by next March unless urgent public health action is taken.

Meanwhile, tens of thousands of people, many reportedly from far right groups, have taken to the streets across several European countries to protest against public health restrictions.

In Australia, anti-science political campaigners Clive Palmer and Craig Kelly from the United Australia Party (UAP) and other right-wing speakers addressed “freedom” rallies over the weekend that reportedly drew thousands of people in Melbourne, Sydney, Brisbane, Perth and Adelaide.

Meanwhile, Australian Government advertising is promoting vaccination using yellow “freedom” messaging that is reminiscent of the UAP advertising undermining public health interventions (see this example from advertisements in Tasmanian newspapers).

While some people in wealthy countries protest against public health interventions, vaccine equity advocates will rally in front of Pfizer Australia’s Sydney CBD office tomorrow (22 November) from 12pm AEDT to protest against the role of pharmaceutical companies in restricting vaccine access in low-income countries, where only 4.5 percent of people have been vaccinated.

The protest will call on Pfizer Australia, which recently announced revenue of $US 36 billion from vaccine sales, to share knowledge and stop lobbying against changes to World Trade Organization intellectual property rules that would allow low-income countries to ramp-up production of COVID-19 vaccines and treatments, said a statement from the organisers. They include Action Aid Australia, Australian Council of Trade Unions, Amnesty International Australia; Australian Fair Trade and Investment Network; Médecins Sans Frontières Australia, Oxfam Australia, the Public Health Association of Australia, Sum Of Us, and Union Aid Abroad – APHEDA.

In such a volatile, confusing and dangerous public sphere – exacerbated by the pre-election political climate – the general public must also come to grips with the complexity and variation in the COVID policies of various jurisdictions.

Warm thanks to public health researcher and Croakey columnist Alison Barrett for providing this useful overview, which also includes a recent analysis of vaccine rollout in nine countries, highlighting the importance of “clear and consistent communication strategies to maintain the trust of citizens”.


Alison Barrett writes:

As COVID-19 cases stabilise and hospitalisations decrease in New South Wales, Victoria and the ACT, other Australian states and territories have announced plans for reopening their borders and moving forward with COVID-19 in the next few months.

It is important to have an effective plan in place as reopening borders and easing restrictions will result in increased cases and hospitalisations in the other states and territories that, except for a few clusters and individual cases, have been relatively free from COVID-19 for the past few months.

In a reminder of how rapidly situations change, the Katherine and Robinson River regions in Northern Territory are managing a worrying outbreak that, as of 20 November, includes more than 30 people.

Following is a brief outline of plans for reopening borders and living with COVID-19 in the community in South Australia, Tasmania, Queensland, Northern Territory and Western Australia.

Note that the plans are complex, vary between states and are subject to change. It is advisable to check current information on the relevant health and/or government websites.

South Australia

On 23 November, people from all Australian states and territories will be permitted to enter SA without quarantining if they are double vaccinated under the South Australia COVID-Ready Plan.

An exception is if people are coming from Local Government Areas with low vaccination rates (less than 80 percent double vaccinated) have community transmission of COVID-19.

People arriving from overseas who are fully vaccinated will be required to quarantine for seven days, instead of the current 14 days.

If domestic and international travellers are unvaccinated, they will need to quarantine for 14 days; this will remain in effect until further notice.

Other restrictions that are currently in place – such as venue density and activity restrictions, mask mandates in indoor public settings and high-risk settings, and private events being capped at 150 people – will remain in place until 90 percent of the SA population (12 years and older) are double vaccinated. As at 17 November, this is predicted to be around 6 January 2022.

SA’s COVID-Ready Plan was developed based on modelling by academics from the University of Adelaide, who are members of the Doherty Institute Network, and specific to SA’s context.

SA Health’s Chief Public Health Officer Professor Nicola Spurrier discusses the modelling and how COVID-19 will be managed in SA  moving forward in this video.

Plans to care for children and keep them safe include COVIDKIDS, a virtual care service supported by paediatric nurses and doctors at the Women’s and Children’s Hospital (WCH) that enables COVID-positive children to be assessed from their home and an upgraded, dedicated space at the WCH for children that require hospital care.

In addition, SA schools’ ventilation systems are being audited. Further advice for schools is intended to be available by 23 November.

While SA’s COVID-Ready Plan is based on best-available data for the state, concerns have been raised about the inequitable vaccination uptake, in particular in regional locations and areas of higher disadvantage where vaccination rates are lagging and not likely to reach 80 percent by the date the borders are due to reopen.

Keep up-to-date with South Australia’s plan here.

Tasmania

Tasmania’s Transition Plan is based on modelling from the Kirby Institute, taking Tasmania’s specific healthcare system and vaccination situation into consideration.

From 15 December 2021, when the state is expected to have reached 90 percent of its population double vaccinated, people who are 12 years and two months and older can enter Tasmania from anywhere within Australia without quarantining unless they have been in a high-risk area of Australia in the 14 days prior to arrival in Tasmania.

If they have been in a high-risk area, they are required to have a negative COVID-19 test within 72 hours before departure for Tasmania. They may also be required to provide proof of vaccination and have a negative test upon arrival.

Fully vaccinated international travellers who are 12 years and older will not be required to quarantine if they have evidence of a negative COVID-19 test within 72 hours before departure for Tasmania.

It is unclear why double vaccinated domestic travellers from high-risk areas may be asked to have a negative test upon arrival, and it does not state that vaccinated international travellers, who arguably will arrive from a high-risk area, are required to.

Unvaccinated domestic and international travellers will need to apply for authorisation to enter Tasmania and if approved, will need to undergo 14-day quarantine in a government-managed facility.

Other public health measures to remain in Tasmania include mask wearing in high-risk indoor settings, the ‘Check in Tas App’, gathering and density limits, testing and contact tracing and isolation of cases and their contacts.

In addition, a plan has been outlined for Hospital Preparedness that includes new beds, intensive care surge capacity and a COVID@Home plan, where COVID-19 positive patients are assessed and triaged to determine the most appropriate environment for them to be cared in. If at home, patient’s health and wellbeing will be monitored remotely by health professionals through smart devices and telehealth.

Concerns have been raised about the disproportionately low vaccination rates in Tasmania’s Aboriginal community; approximately 58 percent are double vaccinated compared to 76 percent of non-Aboriginal Tasmanians.

It is unlikely that 80 percent of Aboriginal population in the state will be double vaccinated by mid-December, which makes them more vulnerable to severe outcomes from COVID-19 when the borders reopen.

Colleagues at Croakey have previously written about the disproportionately low vaccine coverage in Aboriginal and Torres Strait Islander communities across the country and concerns about opening up before sufficient people are vaccinated (here and here).

Keep up-to-date with Tasmania’s plans and restrictions here.

Northern Territory

On 8 November, modelling for the NT was released. It shows that while the Territory is estimated to achieve 80 percent double vaccination coverage (16 years and older) by early December, as in Tasmania and South Australia, great differences exist between regions.

Due to higher risk from COVID-19 in remote communities, a benchmark has been set to achieve 80 percent double vaccination coverage for people aged 5 years and older.

Additional public health measures to minimise the risk in remote communities include mandatory vaccination for any workers entering remote communities (effective 12 November).

And from 19 November, any worker or resident entering a remote community with a first dose vaccination rate under 70 percent from Darwin, Katherine, Alice Springs or interstate will be required to have a negative rapid antigen test within 72 hours of arrival into community.

Keep up-to-date on NT’s plans and restrictions here.

Western Australia

No date has been announced, but WA plans to ease border restrictions when 90 percent of the state (12 years and older) are double vaccinated, according to Western Australia’s Safe Transition Plan.

Vaccinated domestic and international travellers will be able to enter WA without quarantining if they provide proof of vaccination status or medical exemption, have a negative COVID-19 test within 72 hours prior to arrival in WA and a negative test upon arrival.

Unvaccinated domestic travellers will not be permitted to enter. Unvaccinated international travellers will be allowed into WA if they have a negative COVID-19 test within 72 hours prior to travel and undergo 14 days quarantine.

As with the inconsistent rules between domestic and international travellers in Tasmania, it is unclear why it states that unvaccinated domestic travellers are not permitted in WA, when unvaccinated international travellers are.

Other public health measures include mask-wearing on public transport and high-risk indoor venues, check-in via ‘SafeWA App’ or manual contact registers, and proof of vaccination to attend nightclubs, casinos and large events.

Keep up-to-date with WA’s plans and restrictions here. Note, their transition plan has been translated in multiple languages.

Queensland

From 17 December or earlier (if 80 percent of Queensland’s eligible population are double vaccinated), double vaccinated domestic travellers are allowed into Queensland without quarantining or other restrictions if travel is not from a declared hotspot, under Queensland’s COVID Safe Future.

If travel is from a declared hotspot, proof of double vaccination is required in addition to a negative COVID-19 test within 72 hours prior to arrival in Queensland.

International arrivals are permitted if an Australian citizen or permanent resident, fully vaccinated, have a negative COVID-19 test within 72 hours prior to departure for Queensland. Home quarantine may be permitted subject to conditions by Queensland Health.

Once Queensland’s population reaches 90 percent double vaccinated, no restrictions are required for double vaccinated domestic or international travellers. Unvaccinated travellers will need to quarantine.

Queensland’s border plans can be viewed here.

Queensland’s plan for a COVID Safe Future outlines the “new normal,” with continuing public health measures including physical distancing, mask wearing when unable to physically distance, maintain good hand hygiene, stay at home when sick, check in QLD app, and vaccination.

Ventilation audits are being conducted in Queensland schools to determine the need for air filters.

Keep up-to-date on Queensland’s plan and restrictions here.

Lessons from other countries

As Australia reopens both domestic and international borders, some cautionary lessons can be taken from Germany, Netherlands and Singapore.

Germany is currently experiencing high case numbers and hospitalisations, especially in areas with low vaccination rates. The Netherlands has begun a three-week partial lockdown, with curfews and strong encouragement to work from home.

Despite reopening when 80 percent of their population had received full vaccination requirements, Singapore has been experiencing high case numbers since August and hospitals are overburdened.

This is likely due to a high proportion of older people in Singapore not being vaccinated. Additionally, many of the COVID-19 cases in the last few months in Singapore have been in unvaccinated children.

As outlined in a recent piece by Professor Brendan Crabb of the Burnet Institute and Professor Nancy Baxter of the University of Melbourne, relying on vaccines alone is not enough to keep people safe from COVID-19.

A ‘vaccine-plus’ strategy includes vaccinating children, achieving double vaccination in 80-90 percent of the whole country, addressing airborne transmission via targeted mask-wearing in high-risk indoor settings, improving test, trace and isolate systems, and some form of quarantine for high-risk travellers.


Global analysis

Analysing the Launch of COVID-19 Vaccine National Rollouts: Nine Case Studies
Gannon, J et al., Epidemiologia, 23 October 2021

Academics at the World Federation of Public Health Associations analysed COVID-19 vaccine rollouts in Brazil, India, Indonesia, Ireland, Israel, Nigeria, Taiwan, United Kingdom and United States with the aim of learning more about different strategies and which were most effective and which could be improved.

“It is imperative that we scrutinise global efforts to vaccinate against SARS-CoV-2 so that we can improve our understanding of how best to combat infectious agents,” the authors wrote.

They compared aspects of vaccine procurement through to the first two months of vaccine rollout in 2021; and analysed government policies that were available online in addition to health statistics, opinion surveys, news and reports monitoring the progress of the rollout in each of the nine countries.

At the time of analysis (end of February 2021), Israel had administered a first vaccine dose to 54 percent of its population, the UK to 27 percent and the US to 15 percent. Brazil had administered one dose to three percent of its population and Ireland to six percent. Taiwan and Nigeria had not administered any doses at that stage and India and Indonesia to less than one percent of their populations.

Brazil

Even though Brazil has a strong immunisation program, their COVID-19 vaccine rollout started slowly as a result of not procuring enough vaccine doses in 2020 and inconsistent distribution between groups.

A poll conducted in February 2021 indicated that nearly one-quarter of Brazilians would refuse a COVID-19 vaccine, and 56 percent would refuse China’s CoronaVac vaccine.

Vaccine hesitancy and anti-vaccination opinions in Brazil are potentially fuelled by President Bolsonaro, who has downplayed the threat of COVID-19 since the beginning of the pandemic.

It is also a challenge distributing vaccines to remote regions of Brazil, particularly in the heavy rain forested Amazon region.

As at 16 November 2021, Brazil has administered a first dose to 75.8 percent of its population, and 60 percent are fully vaccinated.

Note, Our World in Data vaccination rates are calculated by total population of country (rather than eligible population).

India

India has played a significant role in producing the COVID-19 vaccines, Covishield, which is India’s equivalent to Oxford-AstraZeneca (Vaxzveria), and Covaxin.

Both vaccines are administered in India; however, Covaxin was approved for use prior to the completion of Phase Three clinical trials, which resulted in uncertainty about the vaccine and a low uptake.

Inconsistent communications about the approved use of Covaxin from government officials in January 2021 likely influenced vaccine hesitancy.

In November 2020, 80 percent of Indians were willing to receive a COVID-19 vaccine; however, by February 2021, this had dropped to 42 percent.

Not long after the vaccine rollout began, the Government donated millions of doses to Bangladesh, Bhutan and Nepal. As only a small proportion of India’s population had been vaccinated at this time, the donation was considered controversial by the public.

Fifty-four percent of the Indian population has received at least one vaccine dose, and 27 percent are fully vaccinated.

Indonesia

In early 2021, the Indonesian government had secured 330 million vaccine doses from Sinovac, Oxford-AstraZeneca and Novavax.

Their rollout plan differed to other countries in that they planned to vaccinate 18-59 year olds, public officials and healthcare workers first, rather than prioritising elderly populations.

The reasons given were that this would get working-age people back to work and stimulate the economy, and that younger people are more likely to spread the virus, and thus this would protect older people from the virus.

Indonesia also employed social media influencers to encourage public vaccine uptake, including television personalities, musicians and celebrities.

In November 2020, 30 percent of Indonesians were hesitant to receive the COVID-19 vaccine. Safety and efficacy concerns were the most common reasons for hesitancy.

The vaccines were declared halal, and therefore permissible under Islamic law, and strict penalties, such as fines and withdrawal of social aid, were imposed on people for refusing to get vaccinated.

Distribution is also a challenge in Indonesia, where a large population are spread over thousands of islands.

As at 14 November 2021, 47 percent of Indonesia’s population has received at least one vaccine dose, and 30 percent are fully vaccinated.

Ireland

As a member country of the European Union (EU), Ireland benefited from an agreement to bulk-purchase COVID-19 vaccines to distribute among the 27 EU countries prorata based on population size.

Challenges in their rollout include supply issues from the pharmaceutical companies, government miscommunication and mistrust after leftover vaccine doses were given to relatives of hospital staff not on priority lists.

Despite a slow start, 77 percent of the Irish population has received at least one dose and 75.5 percent are fully vaccinated.

Israel

In 2020, Israel’s Prime Minister made a deal with Pfizer to secure sufficient supply of their COVID-19 vaccine in exchange for real-world safety and efficacy data.

This meant that Israel had enough supply to start rapidly administering vaccines towards the end of 2020.

Vaccination distribution was made easier after many years’ experience preparing for large scale emergencies. Additionally, all Israeli citizens are registered with a Health Management Organisation, enabling electronic communications with them.

To overcome vaccine hesitancy and encourage uptake, a “green card” system was implemented that afforded vaccinated people more opportunities to attend venues and events.

Despite their rapid start, Israel’s vaccine rate has slowed; as at 13 November, 67 percent of its population has received at least one dose and 62 percent are fully vaccinated.

Nigeria

Due to African countries having limited purchasing power, Nigeria were unable to make any deals with pharmaceutical companies to secure vaccines, and thus the biggest influence on Nigeria’s rollout is limited supply and distribution.

“Wealthy nations secured and hoarded hundreds of millions of doses,” the authors wrote, meaning that African countries are reliant on COVAX for obtaining their vaccines.

As Associate Professor Lesley Russell discussed in The Health Wrap, COVAX is approximately 500 million doses short of its vaccine distribution goal.

Nigeria’s vaccine rollout began on 4 March 2021; 2.8 percent of its population has received at least one dose and 1.5 percent are fully vaccinated.

Taiwan

As Taiwan was successful in keeping COVID-19 cases and deaths low throughout 2020, they did not procure vaccine doses until January 2021, and at the time this analysis was completed, they had not yet begun their vaccine rollout.

Additional reading indicates their vaccine rollout began slowly in March 2021; 75 percent of its population has now received at least one dose. Forty percent are fully vaccinated.

United Kingdom

Due to heavy investment in vaccine development and early procurement strategies, the UK were well-placed to begin their vaccine rollout on 8 December 2020.

The rollout was coordinated by the National Health Service and vaccines administered by GPs, pharmacies, mass vaccination sites and hospitals.

As at 14 November 2021, 74 percent of the British population had received at least one dose of a COVID-19 vaccine and 67.5 percent were double vaccinated.

United States:

As per the UK, the US invested heavily in vaccine development and procurement, and were quick to begin their rollout in December 2020.

However, the early rollout was criticised for being hectic, unorganised and lacking clarity. In January 2021, 60 percent of people surveyed said they did not have enough information about when they were eligible to receive their vaccine.

Sixty-seven percent of its population has received at least one dose and 57 percent are fully vaccinated.

Key lessons learned from the early stages of the vaccine rollout

Procurement: Early investment in, and procurement of, vaccines is important to ensuring sufficient supplies are available once clinical trials are complete.

Preparation in the UK and US meant that as soon as the vaccines had been approved for use, they had enough supply to begin mass immunisation.

In contrast, Indonesia and Taiwan were slower in making deals with pharmaceutical companies, and did not secure enough for their entire populations, meaning they had to wait for supplies.

Communication: Good communication strategies are required to encourage populations to get immunised. The analysis found that vaccine rollouts were marred by many communication missteps, including inconsistent and confusing messages.

The leaders of Brazil, UK and the US underestimated the virus, and in the case of Brazil’s President Bolsonaro made incorrect claims about the vaccines, spreading misinformation.

Distribution and logistics: Distribution of vaccines has been hampered by geographical challenges in Brazil and Indonesia, lack of coordination between states and federal governments in the US, and disagreements about optimal locations for vaccination centres in Ireland.

United Kingdom has the advantage of being a smaller country, enabling them to install vaccination centres in close proximity to most people. Israel’s IT system and pre-pandemic emergency drills allowed them to be prepared and efficient in delivering vaccines.

In conclusion, the authors wrote:

Essential ingredients for success include good governance, early support and investment in vaccine development and manufacturing, ensuring robust health and information technology systems to handle the logistical challenges of the operation, and clear and consistent communication strategies to maintain the trust of citizens.”


Resources

COVID live

This website tracks Australian case numbers, tests and hospitalisations, in addition to vaccination rates.

The Vaccine Makers Project

A Vimeo channel that includes animations and videos about how vaccines are made and how they work.

This animation is specifically about how COVID-19 mRNA vaccinations work

• This article was updated on 22 November regarding case numbers in the NT


Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.

See previous editions of the COVID wrap.

COVID-19 Twitter lists

  • Follow this Twitter list for informed news sources, global and Australian.
  • Follow this Twitter list for news from Aboriginal and Torres Strait Islander health organisations and experts.

 

 

 

 

 

 

 

 

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