By Professor Mike Toole AM and Professor Brendan Crabb AC for Nine Media.
Everything is relative. Australia is extraordinarily privileged with a number of effective vaccine options at our disposal, enough to vaccinate every Australian three times over, and no COVID-19 in the entire Australian community. With the Pfizer vaccine rollout under way, the first doses of AstraZeneca administered on Friday, and Novavax to come soon, Australians are quite rightly asking: “When do the COVID-zero brakes come off? And when will things go back to ‘normal’?”
A “normal” Australia is not just one free from any form of internal restriction of movement. It means a return to unfettered overseas travel – incoming and outgoing – and a revival of economically important international tourism and students coming from overseas. To get to “normal” is likely to take most of this year; there is no instant path.
We see two key stages in the return to normal: local recovery, a six- to nine-month period of continued COVID-zero but with a steady increase in local confidence as the vaccine rolls out and, following that, a period of COVID-zero release – that is, to no border quarantine and a true international opening.
As high-risk groups become increasingly vaccinated, the local recovery period should be characterised by an Australia that operates with less and less anxiety about local outbreaks. Confidence in border control is one key to this, reducing the frequency of virus escapes.
One of the most common causes of quarantine leaks has been the failure to effectively prevent airborne transmission in hotel corridors and other open spaces. Originally considered relatively unimportant, this mode of transmission is now widely considered as a significant mechanism of spread which initiated the recent Adelaide, Melbourne and Perth outbreaks.
The plans to build fit-for-purpose quarantine facilities akin to Darwin’s Howard Springs model in Victoria and Queensland are welcome developments in addressing airborne spread. Recent indications that all levels of governments consider airborne transmission to be significant is a major step forward.
Border control should be further improved by the plans to immediately vaccinate border protection workers, which we hope will be extended to their close contacts.
The other key to increased confidence during local recovery is knowledge that in the event of unexpected outbreaks, our most vulnerable people – in particular the elderly, those who work with them and healthcare workers – will be protected from severe disease by vaccination. With these elements in place, local recovery should be complete in six or so months.
But what would it take to transition to COVID-zero release, our opening up to the world?
The crucial question is whether Australia and other countries in our region can achieve a high level of population immunity through vaccination by the end of 2021. The immediate (and appropriate) plan with Pfizer and AstraZeneca vaccines is to protect the most vulnerable people against severe disease.
The decision by Italy to block the export of 250,000 doses of the AstraZeneca vaccine does not significantly impact on Australia’s program given that it represents just 0.2 per cent of the total doses we’ve ordered. It does highlight the wisdom of guaranteeing supply by committing to in-country manufacture of 50 million AstraZeneca doses.
Nevertheless, the current plan won’t lead to population-level immunity. Once Novavax is approved, and vaccines become approved for use in children, it is likely the national strategy will be substantially modified to accelerate the chances of reaching population immunity in Australia by the end of 2021 or early 2022.
But there remain confounding elements that are potential speedbumps. Importantly, there are still questions around how well vaccines prevent transmission, how effective vaccines will be against new variants and how long immunity will last.
Perhaps the most important variable is that of vaccine refusal. Savvy communications will be the key to allaying the concerns of various groups, including culturally and linguistically diverse communities and women. In the latest Essential Poll, only 34 per cent of women definitely intended to be vaccinated compared with 51 per cent of men. There are many drivers of public concern, including confusion driven by well-intentioned public discourse on the vaccine science, as well, of course, as the blatant social media-fuelled misinformation campaign by the anti-vax movement.
Robust responses to all drivers of vaccine hesitancy will be crucial. It was encouraging in the past few days to see the federal government form a specific vaccine myth-busting team to tackle this head-on.
Protecting Australia is not enough for full COVID-zero release. We need to support vaccination programs everywhere, but especially in our neighbourhood. COVID-19 on our doorstep is not just bad for those countries but a significant ongoing threat to Australia. The Australian government has already made generous contributions to the COVAX global vaccination access program and is providing support for logistics and the “cold chain” of freezing and refrigeration throughout transportation, storage and delivery to a number of neighbouring countries.
The main concern now is not one of Australian attitude to this problem, but one of timing. As it stands, there is an unacceptable two-year lag to vaccinate poorer countries.
During all of 2021, and probably into 2022, preventive measures such as wearing masks, physical distancing and hand hygiene will still be needed. Australia developed one of the world’s most effective HIV strategies based on community engagement, culturally appropriate messaging and harm minimisation. These lessons can be applied to maintain behaviour that protects us from COVID-19 as we await the impact of vaccines.
For Australia, although we will still have the COVID-zero brakes on, 2021 promises to be vastly better than 2020. And with a bit of luck, good planning and bold policy action, a year from now should feel a lot more like the world we remember pre-COVID.