OHS Matters: COVID-19 Vaccinations - Where are Things at?

In early April, the Morrison government had been boasting that everyone in Australia would receive the first of the two vaccination doses, at least, by October of this year.

The staged vaccine rollout of the two vaccines that Australia currently has available, the AstraZeneca and the Pfizer, commenced on 22 February this year, organised through the Federal government. High risk, frontline workers and older or vulnerable Australians were to get immunized first. The rollout was supposedly proceeding well: those workers and members of the community in Phase 1a receiving the vaccines before anyone else.

These, as identified by the Federal Government, were:

 Quarantine and border workers. 

 Hospital staff (both clinical and non-clinical) who work in emergency departments, intensive care units, COVID and suspected COVID wards.

 Ambulance staff, paramedics and other emergency service workers.

 Staff in GP respiratory clinics and COVID-19 testing facilities. 

 Staff working in COVID-19 vaccination clinics. 

 Aged care and disability care staff.

 Aged care and disability care residents.

The Federal government has responsibility for the private aged and disability sector, the state governments for those in the public sector.

But by mid-April, the wheels seemed to have fallen off the rollout wagon, with Scottie from marketing dropping the much-repeated October target. There is now no target at all! The vaccine rollout is in shambles. Now, at the end of June, and after a serious community outbreak in Melbourne of two variants of concern, the Delta and Kappa strains, we are still scrambling to get large numbers vaccinated. Now NSW is in the same boat. 

There is a general and widespread criticism for a lack of transparency but here are just some of the things that have gone wrong.

Problems with Supply 

According to the government, Europe was preventing the export of the supplies of the AstraZeneca vaccine ordered by Australia. Italy was reported to have prevented about 200,000 doses from being shipped, and the federal government said the EU was blocking further shipments of the AstraZeneca vaccine. Strangely though, we haven’t heard this excuse for a couple of months.

The Labor Opposition, and some experts in the area criticised the Australian government from the beginning, saying it made a serious mistake in putting almost all of its eggs in one basket. It ordered only 10 million Pfizer vaccines initially to be delivered over one year, but a total of 53.8 million doses of the AstraZeneca: 3 million imported and the rest manufactured here. This is not what other countries such as the UK and the USA did.

While there appear to be no major problems with the Pfizer vaccine - other than very limited supplies and increases not expected until much later in the year - the AstraZeneca vaccine has now been shown to have an extremely serious, albeit very rare, side effect. It’s now beyond doubt that there is a correlation with a very rare type of blood clot. 

The blood clots that are of particular concern are cerebral venous sinus thromboses (CVST), which occur in the veins draining blood from the brain. These can be fatal. This type of clot has also occurred in the abdomen (splanchnic vein thrombosis, or SVT) and in arteries in some who have received the vaccine. In most of the patients identified so far, these clots occurred in combination with thrombocytopenia, a condition characterised by abnormally low numbers of platelets and sometimes bleeding. This is counter-intuitive as, usually, having low platelets creates an increased risk of heavy bleeding, because it makes it harder for blood to clot. 

In other words, these are not the ‘usual’ blood clots (eg DVTs) and when diagnosed are not treated in the same way nor with the same medications. 

The estimation is that between one in 100,000 and one in 250,000 people receiving the first dose of the AstraZeneca vaccine have developed these clots. Some have died. In Australia, there have been 60 cases identified, 37 confirmed, 23 probable. This has grown from just two cases by mid-April. 

In early April, quite some time after many other countries around the world, the Australian Technical Advisory Group on Immunisation (ATAGI) advised that the Pfizer vaccine was preferred over the AstraZeneca vaccine for people aged under 50 years. However, it also advised that even in adults aged under 50 years where the benefits of protection against COVID-19 are likely to outweigh the risks of the side effect, the AstraZeneca vaccine can be used. But with the cases increasing, and two people in their 50s dying as a result of the clots, ATAGI last week amended its advice: the AstraZeneca vaccine is no longer recommended for people aged under 60.

The federal government has now expanded access to Pfizer to all Australians aged 40 to 59.

The decision puts further strain on the federal government’s vaccine rollout which will now have to rely even more heavily on imported Pfizer doses. Millions of doses of AstraZeneca, previously the backbone of the rollout plan, are being produced in Melbourne, but Australia does not have the capacity to build mRNA vaccines like Pfizer and Moderna.

Problems with the Rollout

Initially, the Pfizer vaccine should have been directed to under 50 yr-old workers in Phase 1a. It has emerged, however p, that the rollout has been badly mishandled:  

 Aged care residents we’re, and continue to be, vaccinated with Pfizer; and dozens of facilities somehow ‘’missed out’’ altogether. 

 Many workers in Phase 1a have not only not received either of the vaccines, but have no idea when they might be getting it.  I April a Queensland doctor and nurse treating suspected COVID patients were diagnosed with COVID themselves. Neither had been vaccinated.  

Just after Easter the Australian Nursing and Midwifery Federation (Vic Branch) released the findings of a survey it ran amongst some of its members. The survey revealed that 86 per cent of Australian Nursing and Midwifery Federation (Vic Branch) private aged care members – nurses and personal care workers – had not received a vaccination. Of those who had been vaccinated, most had become tired of waiting for the promise of a workplace vaccination and had sought to arrange their own vaccination through their private GP.

Even worse, media reports at the same time found that many aged care and disability workers were “scrambling to source their own COVID-19 jabs”. 

As a result, the ANMF (Vic branch) called on the Federal Morrison Government, responsible for the vaccination of private aged care residents and staff across the country, to urgently ask the Andrews Government to take on the vaccination program for the Phase 1a private aged care workforce.

ANMF (Vic Branch) Secretary Lisa Fitzpatrick said ‘The Morrison Government must prioritise vaccination of private aged care staff at work given the hundreds of resident deaths in this sector last year. Their hands-off approach ignores the brutal aged care lessons we learned during last year’s COVID-19 outbreak.” Ms Fitzpatrick said, “By outsourcing their responsibility under the guise of choice, the Morrison Government has abandoned private aged care nurses, personal care workers and other staff.”

The union says that the Victorian Andrews Government, which is responsible for the vaccination of public aged care residents and staff, is using an effective combination of outreach services and vaccinated with many having received their second dose.

It has since been revealed that the companies contracted by the federal government to vaccinate the aged care homes did not include staff, who were told to organise it themselves with their own GP. Even more shocking is that the federal government has no idea the extent of immunization in aged and disability sector workers.

And yet according to the ABC’s Dr Norman Swan, there should have been adequate numbers of vaccines for all people in Phase 1a to be vaccinated over a short period. 

The Morrison government has ordered 20 or 30 million more doses of Pfizer, and the company has reportedly said that there is no issue with supply – although there must be some issue as Australia is not getting them fast enough. 

Earlier this year, some were asking: why does it matter anyway? We had negligible numbers of infections in the country, and assuming Australia’s quarantine program identifies incoming travellers with COVID-19, we had community infections under control. Why shouldn’t countries undergoing their third and even fourth wave of COVID, with huge numbers of infections and deaths get priority when it comes to vaccinations? 

Well, people’s views changed quickly when a more virulent strain of the virus ’leaked’ out of a quarantine hotel in Adelaide. A returning traveller who caught COVID in the hotel, came home to Melbourne and triggered our current outbreak - and lockdown number 4. 

There had been an issue of “vaccine hesitancy” - but no more in Victoria, with queues and booking sites and hotlines clogged with those of us wanting that first shot. Despite this, due to supply issues, we remain at appalling low rates. Australia has just 4.7 per cent of our population fully vaccinated (23.9 per cent has received the first dose). Compare this to Italy and the UK: 29.1 per cent and 48.4 per cent respectively, fully vaccinated. The Australian government has well and truly f*#&ed up!

In any case, the question was no longer simply one of health. It is a political and economic one. Even if we were not at risk of high levels of infection, as countries vaccinate their people, the world will open up to travel and commerce, and we won’t be able to. We will be isolated: unable to travel to visit family or go on holiday – and the many millions of tourists and international students on whom so many of our jobs rely, will not be able to come to Australia either.  So, the shambles must be sorted out - the sooner the better.