Hal Swerissen

Australia has gone for an elimination strategy on COVID-19 – no community spread – and we’ve been remarkably successful. But the vaccination rollout has been disappointingly slow, and we now urgently need a plan for the medium and longer term.

Political and health leaders are reluctant to use the phrase, but Australia’s ‘elimination strategy’ has been so effective that any community transmission is now regarded as unacceptable. To make elimination work in the longer term, the plan was that everyone was to be vaccinated this year to protect against widespread outbreaks. In theory we could then go back to normal, or something like it.

In the meantime, quarantine was to be watertight, with gold standard contact tracing if there was leakage. If quarantine and contact tracing failed, the plan was that there would hotspot lockdowns and then general lockdowns as a last resort to stop out-of-control spread. Governments would provide compensation for the social and economic costs of lockdowns.

But those costs are high, and unlikely to be sustainable in the longer term. And vaccination has been slow.

In Australia, less than 20 per cent of the population has had at least one dose of the two required. Israel, the UK, and the US are all above 50 per cent. Most of Europe is at about 40 per cent.

A number of the wealthy countries with low transmission – Australia, South Korea, New Zealand, and Taiwan – have very low rates of vaccination. It looks as though there has been a trade-off between controlling the virus and vaccine urgency. Complacency has set in.

The most damning part of the slow rollout in Australia is that residential aged care staff and residents and people with disabilities are not fully vaccinated.

More than 900 Australians have died from COVID-19. About 75 per cent of those peole were residents in aged care facilities. When a resident in an aged care facility catches COVID their chance of dying is 40 times higher than for people in the community.

The biggest risk is that aged care residents will catch COVID from a worker. Yet only about 20 per cent of all aged care workers and 25 per cent of residents have received at least one dose of vaccine through the Federal Government’s aged care vaccination program. Only about 4 per cent of people with disabilities living in residential care have received a vaccination.

Not surprisingly, following the Victorian outbreak in May, the Federal Government is scrambling to fix the vaccine rollout in aged care and disability. Now, the discussion is beginning to shift to the longer term.

The elimination strategy is not fit for the longer term

The elimination strategy has been controversial because it turns out it’s hard to control quarantine leakage and trace all contacts. So costly lockdowns continue to be imposed, leading to bickering about whose fault it was and whether the lockdown was really necessary.

We haven’t got much COVID now, but our current plan is not working very well and it is not fit for the longer term.

There are monthly outbreaks from quarantine, and contact tracing only works some of the time. There are regular hotspot lockdowns, and occasional widespread lockdowns. There is only grudging, reactive, and chaotic support for workers and businesses affected by lockdowns.

Australians now have a yo-yo lifestyle – lockdowns followed by comparative freedom followed by lockdowns and so on. We need a new plan.

Beyond elimination

National Cabinet should stop the bickering, fix the current problems, and produce a plan for the longer term.

Several measures seem obvious.

To start with, at the moment there is no clear vaccination target. Having one would help.

Most of the evidence suggests between 70 per cent and 90 per cent is the level needed to keep the community safe from serious disease and death. Let’s aim for 80 per cent of Australian adults being fully vaccinated by Christmas.

But there is no certainty that even an 80 per cent vaccination rate will eliminate community transmission. If all public health measures are then dropped and life goes back to pre-COVID normal, some people are still likely to catch COVID and some of them are likely to die.

So we may have to accept a reasonable level of COVID infections and deaths, as we do with other diseases, or we will need to accept the yo-yo lifestyle. The question is: what is reasonable and acceptable?

Beyond a vaccination target, we need a plan that gets beyond piecemeal discussion of ‘vaccination passports’ and purpose-built quarantine facilities.

Once we reach 80 percent vaccination levels, a controlling COVID strategy may be the best option. One that aims to limit community spread to acceptable levels with some ongoing limits on what we can do, but without the massive costs of regular widespread lockdowns.

In the medium term, controlling COVID probably means ongoing restrictions for the unvaccinated.  Testing, symptom checking, and border restrictions for travellers from risky countries are likely –including targeted quarantine. Tight contact tracing and restrictions to manage clusters will still be needed, particularly for vulnerable populations and risky workplaces. But widespread lockdowns should be no more.

Australians are probably going to have to accept some basic behaviour changes. Vaccination may have to become a public duty, like wearing a seat belt. Not wearing a mask in risky places like public transport may become socially unacceptable, like smoking on the tram. Handshakes, hugs, and kisses are probably no longer a good idea accept with immediate family and very close friends. Going to work or school with a cough and the sniffles is likely to be frowned on, rather than being seen as a badge of honour and commitment.

The longer term future for COVID years from now isn’t clear yet. We are still learning about COVID and its impact. COVID may mutate and become less dangerous and more of an irritant but we simply don’t know yet.

Our leaders should level with us about the hard choices ahead. If our long-term aim is that no Australian should ever die from COVID, we will have to live with the yo-yo lifestyle of lockdowns for the long term. If we don’t want that, we will need to adjust to a level of community COVID disease and death, much as we do with influenza.