I Have Vaccine Questions, Morrison’s Still Not Answering

There’s less than three weeks to go before Australia’s largest, most complex and most crucial public health initiative, and all we’ve got for answers is four PowerPoint slides8. Where are all the details? We don’t know, they haven’t told us.

So far the only thing we’ve been successfully inoculated against is Morrison’s incessant announcements about things we haven’t got yet, or that haven’t yet happened. Actual facts and details, however, like the vaccines, are still nowhere to be found. There has been a lot of bullshit, as I’ve already remarked.

Let me be quite clear, though: I am absolutely in favour of every Australian possible being safely and effectively vaccinated against Covid-19 as soon as possible. It is the single most important and effective step we can take; as individuals, as a society, and as global citizens. Nothing I say here is intended to deter anyone from getting safely and effectively vaccinated at the earliest opportunity—but note “safely” and “effectively”.

Note also that until we’re all safe, either through near-universal vaccination or through herd immunity, it’s vital that we preserve the protections and protocols that have allowed us to effectively eliminate (not eradicate) the virus from our country. The consequences of failures in those protections—in quarantine, and in aged care—are the cause of the large majority of our cases and deaths, and we need to continue with that protection until we’re all safe. How we achieve that safety is mostly a mystery, however, and I have many unanswered questions.

My questions are about how the Morrison government intends that rollout to happen—beyond four PowerPoint slides—and what it plans for us while it happens, and what it plans for us after it happens. On that, it’s disturbingly silent, although there are glimpses in “vision” statements that are clearly intended to soften us up for what’s coming.

Everybody’s fantasy at the moment is that life will return to “normal”, at least inasmuch as all of the constraints and restrictions imposed by Covid-19 should go away: no more lockdowns, no more social distancing, no more masks, no more capacity limits, no more travel bans and restrictions, no more bans on tourism and tourists, no more quarantine, no more fear and obsessive hand-washing. No more announcements by Morrison…

However we’re really totally in the dark as to how, when and whether we’ll achieve any of that. One moment Morrison is telling us “COVIDSafe practices will be a lived experience in 2021,11” and in the next breath he’s talking about opening international borders, saying “we’ll see how things play out in the course of the year.12” So which restrictions will go first? When? What will be the trigger? Until we have finished the vaccination rollout large numbers of Australians will still be unprotected; what are the implications for them, and for people for whom a 62% efficacious vaccine didn’t work?

Is the government intending to achieve herd immunity? Are its protocol relaxations based on that assumption? How will they decide? We don’t know, they haven’t told us.

Recently Morrison said that “case numbers will be less of a focus once vaccines roll out”5. What does that really mean? That it won’t matter about outbreaks any more? We know that the rhetoric about even failed vaccinations “providing protection against serious illness and death” is just false13,14. Until we have proper measures and reliable statistics on this, we simply don’t know, and hopeful speculation by a Chief Health Officer borders on negligence.

Case numbers and deaths are inextricably linked. So when is “once vaccines roll out”? Does Morrison mean this at the beginning of the rollout, or once everybody is vaccinated? We don’t know, they haven’t told us. A Prime Minister shouldn’t make statements like this without being quite clear what it means for Australia, and three weeks from the start of a huge national program we expect concrete, specific information, not aspirational statements that pretend we’ve already achieved our goal—whatever that is.

Right now we’re in the dark about many of the basic but important details of the execution of the vaccination program, questions that ought to be answered before the first shot is delivered. (No doubt that first shot will be a shot of the most effective vaccine, delivered to Morrison “to reassure the public”, because otherwise he’d have to wait until July or August or so for a chance at a 62% effective vaccine.)

So, what are these questions? Let’s break them down a bit.

We’ll run out of “guaranteed” Pfizer before the end of Phase 1

The following diagram is an annotated version of part of the Health Department’s own four-page rollout strategy, the best information we have so far! You can see a larger version of the original here if you wish, however don’t worry, the important details are described below in the text.

The diagram shows the planned phases of the rollout. Phase 1, the first two boxes, is supposed to use the 95% efficacious Pfizer vaccine, but instantly you can see there’s a problem, because the 10 million doses we have “secured”1 run out well before the end of the Phase 1 list, the first red line in the middle of the second box. In fact they run out leaving 1.8 million vulnerable, Phase 1 Australians unprotected.

Clearly this wouldn’t be a good time to stop “focus on case numbers” or reducing our protections. Perhaps a bit later? But when? We don’t know, they haven’t told us.

Running out of Pfizer means that either they’ll have to wait for the second tranche of Pfizer vaccine or they’ll have to be vaccinated with the 62% efficacious AstraZeneca vaccine instead, meaning at least 38% of them, or about 700,000 highly vulnerable Australians, won’t be protected. When will the second Pfizer tranche arrive, and what’s Morrison’s strategy? We don’t know, they haven’t told us.

This, of course assumes that the AstraZeneca vaccine is approved by the TGA.

However it’s worse than that. We already know that the AstraZeneca Phase III trial results had practically no subjects over the age of 55. As a result, a large number of European countries have decided not to use AstraZeneca at all for their older populations: so far Germany, Austria, Sweden, Norway, Denmark, Netherlands, Spain and Poland only recommend it for people under 65, and Italy and Belgium for those under 55. Switzerland has refused to approve it at all until more data is available6.

If we start vaccinating with AstraZeneca before the second tranche of Pfizer arrives we could end up using it on 25% of the population for whom there’s really no clinical data, and for whom most European countries have declined its use. It may work fine. Equally, it may not. This is not an experiment you want to get wrong before you start allowing international tourists back in, for example.

Because there’s little data, we don’t even know what the efficacy is for over-55s. At an optimistic 62% efficacy that will still mean another 2.4 million Australians vaccinated but failing to be protected.

Even if the second tranche of Pfizer arrives in time, the next 10 million doses will run out when we’ve hardly started vaccinating 50-59 year olds, the orange line only a short way into the third box, Phase 2a. That will leave around one million over-55s being forced to use AstraZeneca, with unknown efficacy.

Now at this point you’re perhaps wondering whether, or when, any of the other vaccines the government claims to have “secured” will become available. We don’t know, they haven’t told us. We’ve been given absolutely no information, and it’s a safe bet that if the government actually knew when any of these vaccines was arriving they’d do one of two things: they’d either make an announcement—their specialty—or, if the date was disappointingly far away they’d keep quiet about it and leave us guessing, or use vague promises like “some time in Q3”. Their silence suggests then that, either way, it’s some time off, so for now we should assume only Pfizer and AstraZeneca.

Which leads to the next question: presumably the government has done some risk management on its rollout strategy, and has contingencies in place for what to do if even the “secured” doses fail to arrive: for example, a slowdown in the Pfizer plant (that has already happened once9), or some local ramp-up problems with the Astra-Zeneca vaccine (also already happened once10). What will this mean for people who’ve already had their first dose? Or for people in the queue? Will they switch to single-dose regimes? Mixed vaccines? We don’t know, they haven’t told us.

Clearly if you’re in Phase 1, or over 55, unless you’re in the groups expected to be covered by the first tranche of Pfizer vaccine you’ll probably be faced with some difficult choices, assuming you’re allowed the choice: whether to wait for tranche 2 of Pfizer with an unknown delivery date (and possibly lose your place in the queue? We don’t know, they haven’t told us), or accept the much less efficacious AstraZeneca. In either case, however, you’ll be faced with the next important but unanswered question:

What if it doesn’t work, and will I even know if it hasn’t?

If we continue to observe all of the current safety protocols we’ve been using up until now, your chances of catching Covid-19 are very low. We’ve been fortunate. However all of the signals coming from government clearly indicate that at some point those protocols are going to be relaxed or abandoned. Borders opened, international flights resumed, quarantine waived; all of these have been mentioned, in passing, by government ministers.

What they won’t say is when, which, or why. We don’t know, they haven’t told us.

At the point that restrictions are relaxed it will become much more important to each of us to know, if we’ve been vaccinated, whether or not we’re protected. Equally, it will be potentially both frightening and dangerous for those of us who haven’t yet been vaccinated to have to live in an environment without all the protections that have kept us safe for 12 months.

But how will you know? If you’ve been vaccinated with AstraZeneca there’s a roughly four in ten chance it won’t have worked, possibly greater if you’re over 55. How will you know? And, just as importantly, what—if anything—will you be able to do about it? We don’t know, they haven’t told us. Yet another subject on which the government has been totally silent is what will be done for people in this situation. Even if ten million of us receive the Pfizer vaccine—leaving possibly half a million unprotected—that still leaves another ten million potentially receiving AstraZeneca, which will mean at least four million Australians unprotected, possibly more, depending on the efficacy for over-55s.

This isn’t enough for her immunity15, and it ignores the ten percent or more who say they won’t be vaccinated anyway; that’s another two and half million Australians, raising the total to a quarter of the population. It raises again the frightening possibility that the government will be prepared to accept a much higher death toll as soon as the risk of an out-of-control outbreak is averted. It’s worth remembering that in the early days of the pandemic Morrison was exhorting us to “live with the virus” and proposed going to a footy match. The constant attacks on State Premiers who have locked down harder rather than playing Russian roulette with their populations have shown what Morrison’s preferred course is, and it’s business profits first and people’s lives second.

Maybe before we end up with a quarter of us unprotected some other, more efficacious vaccine will be available, but whether it will be, when it will be, and how the government intends to manage the allocation of the differing efficacies… We don’t know, they haven’t told us.

Again, what is the government’s plan and strategy for restrictions? We don’t know, they haven’t told us.

What’s the “certificate” for?

If you’ve been vaccinated, though, we’ve recently been told that those vaccinated will receive, by email, a vaccination “certificate”7. There’s absolutely no information about what the certificate will contain, whether it’s verifiable, how open to abuse it is, and for what it will be used; we don’t know, they haven’t told us. The usual opacity from the Morrison government.

Since for vaccination you’ll be identified by a driver’s licence and your details will be in a national vaccination database it’s fair to assume it won’t be needed to to re-identify you to medical authorities, which only leaves it as proof of vaccination for others – a “vaccine passport”. How will this be used? We don’t know, they haven’t told us. Who will be allowed to demand it? We don’t know, they haven’t told us. Since, currently it’s certain that some vaccinated people will not be protected, and also quite possible that protected people may become infected and spread the disease, a “passport” may protect neither the holder nor the people who believe what it claims. So how it this to be used safely? We don’t know, they haven’t told us. If it’s used before vaccination is completed it may create “haves” and “have-nots”, and going forward this may extend to entire countries, but while the government has clearly decided to create these certificates and has told us about them, they haven’t revealed a single thing about why.

There’s more, but…

It seems hard to believe that, right on the brink of this huge logistical exercise there are so many questions unanswered, and that’s not all of them. Certainly the experts and the government know the answers to at least some of them, however they’re choosing to keep us in ignorance deliberately. “For our own good,” no doubt. It’s also possible, likely even, that some of the things they should know the answers to they don’t, but they’re too proud or too arrogant to admit it.

Ultimately none of this will work in their favour, or ours.

If you’re in Phase 1 and are one of those for whom the first tranche of Pfizer vaccine will run out before you’re vaccinated: a younger adult with a disability or critical condition, or a critical or high-risk worker such as defence force or police; or if you’re over 55, then you will have to decide what to do if the second tranche of Pfizer doesn’t arrive before you’re due to be vaccinated: to wait, or chance the AstraZeneca. Equally, if you’re under 55 but would like a better than six in ten chance that your vaccination will actually protect you then you’ll face a similar decision if the only vaccine available at the time is AstraZeneca.

As I remarked at the beginning of this article, however, the difficulty in making this choice is in knowing which is the safer and more effective path when all the information you need is being withheld by the government.

Those choices would be simplified, or possibly wouldn’t need to be made if Morrison and his government simply revealed the answers to these questions, or at the very least were honest about the ones to which they also don’t yet have answers. Going on past performance, however, they far prefer silence and denial to revealing plans and being held to them, or admitting ignorance or fault, even if it damages the nation.

Three weeks and counting, and we’re still in the dark.

  1. https://www.abc.net.au/news/2021-02-01/scott-morrison-coronavirus-vaccine-rollout-economic-recovery/13108194
  2. ((25,360,000 – 500,000) * 2 / 266) = 186,917
  3. https://www.abc.net.au/news/2021-02-06/covid19-vaccine-certificate-planned-for-australian-rollout/13125214
  4. https://thenewdaily.com.au/news/2021/01/04/vaccines-delivered-australia-two-months-before-jabs/
  5. https://www.theguardian.com/australia-news/2021/feb/05/covid-case-numbers-will-be-less-of-a-focus-once-vaccines-roll-out-scott-morrison-says
  6. https://www.bbc.com/news/55919245
  7. https://www.abc.net.au/news/2021-02-06/covid19-vaccine-certificate-planned-for-australian-rollout/13125214
  8. https://www.health.gov.au/sites/default/files/documents/2021/01/australia-s-covid-19-vaccine-national-roll-out-strategy.pdf
  9. https://timesofmalta.com/articles/view/pfizer-vaccine-deliveries-delayed-in-europe-says-norway.845277
  10. https://www.politico.eu/article/astrazeneca-coronavirus-vaccine-deliveries-to-eu-reduced/
  11. https://www.pm.gov.au/media/press-conference-australian-parliament-house-12
  12. https://www.abc.net.au/news/2021-01-19/international-travel-last-thing-to-return-coronavirus-borders/13070538
  13. Will covid-19 vaccines save lives? Current trials aren’t designed to tell us
  14. https://www.theaustralian.com.au/science/astrazeneca-covid19-vaccine-claims-not-evidencebased/news-story/401d82d8f353b6239372ca9b4f557161
  15. https://www.thelancet.com/article/S0140-6736(20)32318-7/fulltext