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 rather 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, was a full-blown plane crash. Somehow, one of the richest countries in the world and the home to CSL, one of the largest global biotechnology manufacturers, looks set to be slower than developing backwaters in vaccinating their population.
The errors have been caused by combination of hubris, garden variety incompetence and an unfounded paranoia about vaccine hesitation.
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 diversity the vaccine supply. No vaccines were ever ordered from Moderna or Johnson & Johnson (nor the Sinopec or Sputnik — albeit that is far more understandable). 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 of the vaccine rollout was the abrupt cancellation by the government 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 became 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 1 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 UQ’s vaccine.
At the time, the decision appeared strange — now it appears utterly idiotic.
Around 800 people contract HIV in Australia each year, a tiny number compared to our population. 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 and the vaccine rollout experienced more delays.
Mistake four was the glacially slow TGA approval process. As we observed earlier this week, there was nothing stopping the government to legislate an emergency approval process. This, coupled with mistake number one, meant that 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. Sub-mistakes within this mistake include 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 to not stuff anything up when it comes to the vaccine rollout.
Mistake six was the government yesterday accepting the recommendation of the Australian Technical Advisory Group on Immunisation. The terms of reference of the group are to provide technical advice on the immunisation program and to identify and prioritise gaps in the immunisation landscape.
The group’s advice or recommendations are not binding, so the government could have simply 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 vaccine 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 like 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 agreed between 15-50. 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 Prime Minister 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). But we don’t strongly recommend people to have those procedures. We also allow people to sky dive, or bungy jump, or drive cars or smoke cigarettes — all of which are far far more dangerous than the AstraZeneca vaccine.
Leaving aside the federal government’s many other failings, unless it can somehow purchase 20 million doses of the Moderna or J&J vaccine, the vaccine disaster will mean the Morrison administration will rightly be remembered as Australia’s most inept.