Malcolm Gladwell observed that in your average plane crash, seven distinct human errors usually occur. Planes don’t crash because a pilot falls asleep or presses one wrong button, but a series of calamities, each usually avoidable, combine to cause a tragedy. The same can be said for the disaster that has been Australia’s vaccine rollout.
Already a debacle, by 7.15pm last night it was a full-blown plane crash. Somehow, one of the richest countries in the world, home to CSL, one of the largest global biotechnology manufacturers, looks set to be slower than many developing nations in vaccinating its population.
The errors have been caused by a combination of hubris, garden-variety incompetence and an unfounded paranoia about vaccine hesitation.
7 distinct errors
Mistake one was taking far too long to sign agreements with pharmaceutical businesses. Australia took several months longer than countries like the US, UK and Israel to actually purchase the vaccines.
Mistake two was failing to diversify the vaccine supply. No vaccines were ever ordered from Moderna or Johnson & Johnson (nor the Chinese Sinopec or Russian Sputnik — albeit more understandably). Ten million doses were ordered from Pfizer (later upped to 20 million), and then the government was relying on AstraZeneca, the delayed Europe-produced Novavax and the University of Queensland’s vaccine.
Mistake three was the Morrison government’s abrupt cancellation of UQ’s vaccine. This decision got minimal publicity at the time — largely because the government very quickly said CSL would switch production to AstraZeneca. However, the cancellation concentrated supply risk onto only three producers (the impact of that becoming obvious last night).
The thing is, there was nothing actually wrong with the vaccine’s efficacy (that had been noted anyway) — the issue was participants in the vaccine’s phase one trials had returned “false positive” HIV tests. The vaccine, a molecular clamp, was formulated using HIV proteins. The government, presumably fearing public backlash, were very quick to dump this vaccine.
At the time, the decision appeared strange — now it appears utterly idiotic. About 800 people contract HIV in Australia each year, a tiny number. Presumably, rather than completely dump the UQ vaccine, other measures could have been taken to handle the rather minor false-positive issue. But instead, the government switched to AstraZeneca.
Mistake four was the glacially slow Therapeutic Goods Administration (TGA) approval process. As we observed earlier this week, there was nothing preventing cabinet legislating an emergency approval process. This, coupled with mistake one, meant our rollout was almost six months slower than the UK and US.
Mistake five was using GPs (and paying them a pittance) to roll out the majority of the vaccine, rather than mass-vaccination hubs.
Mistake six — actually a sub-mistake within mistake five — included creating an online booking platform to allow GPs to accept bookings, suggesting people book before GPs even had the vaccine, and then providing the GPs with far less vaccine than had initially been promised. The states last week started creating their own mass-vaccination hubs, finally realising that the federal government can’t be trusted not to stuff anything up.
Mistake seven was yesterday’s acceptance of the recommendation of the Australian Technical Advisory Group on Immunisation. The group’s terms of reference are to provide technical advice on the immunisation program and to identify and prioritise gaps in the immunisation landscape. Its advice or recommendations are not binding — the government could simply have ignored them, accepted the political risk, and suggested only those under 30 avoid the AstraZeneca vaccine.
There is a yet-to-be-proven causal link between the AstraZeneca vaccine and blot clots in younger people. Around one in a million people who received the AstraZeneca jab in the UK suffered clotting (and some of them died). Several countries suspended the vaccine for use in younger people, but the important point is those countries — such as Canada and the UK — had ample supply of other vaccines that could do the job, so there was no real impact. That certainly isn’t the case in Australia, courtesy of mistake two.
Australia needs to use its dwindling supply of Pfizer on the 12.5 million Australians aged between 15 and 50. The problem is, we only ordered enough vaccine for 10 million Pfizer vaccinations, and a few million have been used already. (Not to mention the Pfizer doses will take longer to arrive than AstraZeneca.)
As Scott Morrison himself said last night, the contraceptive pill has a far higher rate of blood clots than AstraZeneca, yet we happily prescribe the pill to millions of women and let them weigh up the risks and benefits. Moreover, there are risks in almost every medical procedure that are significantly higher than that of AstraZeneca (which is yet to show a causal link). We allow people to skydive, or bungee jump, or drive cars, or smoke cigarettes — all of which are far more dangerous than the AstraZeneca vaccine.
Unless the Morrison administration can somehow purchase 20 million doses of the Moderna or Johnson & Johnson vaccine, leaving aside its many other failings, the rollout disaster will see this government rightly remembered as Australia’s most inept.