The federal government’s promise that every eligible Australian would be vaccinated against Covid-19 by October was “always stupid, patently so,” leading health economist and director of the Grattan Institute’s health program, Prof Stephen Duckett said.
It means the government now has a difficult job ahead of it in rebuilding confidence in the vaccine rollout and preventing vaccine hesitancy, he said.
On Wednesday night, the government announced a recommendation that alternatives to the AstraZeneca vaccine be offered to those aged under 50 due to an approximately one-in-4m risk of severe blood clotting.
Duckett said the government advice on the rare clotting was sensible, and that Australians should still have confidence in the overall safety and efficacy of the vaccine. But the public had already been fatigued by promises about the rollout that had gone unmet, he said.
“Over the last eight months the public has been convinced by politicians that we’re only implementing measures like closed international borders and lockdowns until the vaccine arrives,” Duckett said.
“So the vaccine became really, really important to the public, and this importance was heightened in August when the government said, ‘we now have signed contracts to secure the vaccines’. So the public got a whole lot of expectations about what would happen once we got the vaccine, with travel reopening and things returning more to normal. When the government first started making announcements about the numbers of people who are going to be vaccinated, they believed them.
“But there was quickly a massive gap between the promise and the delivery.”
Despite #ClotMorrison and #ClottyFromMarketing trending on Twitter by Friday afternoon, the government could not be blamed for the clotting issues with AstraZeneca, he said.
“That was not something they could have foreseen.” But Duckett said other issues could have been foreseen – including vaccine nationalism, which involves other parts of the world blocking exports to secure their own supply.
“That risk was known before the government made its vaccine targets public,” he said.
“The government has failed to achieve its targets and that’s because those targets were stupid right from the start. Patently so. Let us assume there were no international supply chain problems. We still would not have achieved those targets.”
Peak medical bodies including the Australian Medical Association (AMA) and the Royal Australasian College of Physicians (RACP) rushed to reassure the public on Friday afternoon. AMA President Dr Omar Khorshid said: “This setback may slow down the vaccine rollout, but it also means the rollout is based on the best advice possible – it is not a race to the finish line.”
“The clotting seen in few patients around the world is extremely rare,” Khorshid said. “I want to emphasise the AstraZeneca vaccine for people who are 50 and over is considered very safe and the benefits vastly outweigh any risks.”
RACP president, Prof John Wilson said: “It is still far better to be protected from Covid-19 than not.”
“The Covid-19 AstraZeneca vaccine can be used in adults aged under 50 years where the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits,” he said.
Prof Julie Leask, a social scientist whose research focuses on infectious disease, immunisation controversies and vaccine hesitancy, said most people would understand the risk of rare clotting was low.
“It’s not like people are naive to these kinds of medical risks or can’t cope with this knowledge; they can, and they do all the time for other medications,” she said. “They know most medicines can come with rare but serious side-effects.”
But she agreed with Duckett that other issues with the rollout had jeopardised overall confidence, adding that “bickering between the state and federal governments hasn’t helped”.
“We also have real practical issues that can harm vaccination programs and uptake, such as people now being confused about when and where and how they can get a vaccine,” Leask said.
“And we’ve got quite a lot of public anger and expectation that we’ll get vaccines as soon as possible. We are now caught in this tension between the demand for vaccines, but not having enough of the vaccines that suit our population now. This is a very difficult position for policymakers, and for the Australian public, to be in.
“I think there’ll be discontent and the government will need to brave that discontent and keep communicating. There’s this public anger about the rollout driven by very high and unrealistic expectations about how fast this rollout can happen, and not really understanding how difficult and complex the process is. But that has not been helped by government pronouncements about targets of October.”
Leask said at this point, the government should “take a pause, and review what’s been going wrong so far to try and reset and fix a lot of those governance and logistical issues, including squabbles between states and the federal government.”
The public might accept the changes that now have to happen and the rollout going forward if they received good, easy to understand advice from health professionals, she said. “The government will really need to prioritise communication with all of its health professionals, including nurses who vaccinate but who are often left out in the planning process,” she said.
“The government must also communicate the risks and benefits with community leaders, particularly with culturally and linguistically diverse communities, because there’s a real risk of great confusion here as information filters down, including misinformation or distorted information.”
Deakin University’s chair in epidemiology, Prof Catherine Bennett, said the government had been transparent about the vaccine itself in terms of the safety and efficacy. But they needed to balance communication about risk and harm with emphasising the risks of not being vaccinated, she said.
“Even with experts this is a challenge because people have different risk perceptions. We are looking for really rare side-effects, and then looking at the few people who might be at risk of those rare events, and then we talk a lot about those rare events while also trying to manage everyone else’s perceptions about that risk.
“That level information and communication doesn’t happen in one press conference.”