How much of Australia’s vaccine supply should be exported?

Jolyon Attwooll

1/07/2021 5:05:50 PM

With predictions of local oversupply combined with shortages elsewhere, a virologist, bioethicist and GP share their views with newsGP.

Empty vaccine vials.
General practice has an AstraZeneca dose utilisation of 74% compared to an overall national rate of 81%. (Image: AAP)

In what has been an eventful week for the country’s vaccine rollout, the National Cabinet considered exporting Australia’s current supply of the AstraZeneca vaccine to other countries, The Guardian has reported.
The option has been shelved – for now – but the question of vaccine distribution to the Pacific region remains alive.
A total of 50 million AstraZeneca doses has been ordered from biotechnology company CSL, which is manufacturing the vaccine in Melbourne. Supply of that vaccine is set to significantly outstrip demand in the coming months, while Pfizer will continue to experience shortfalls.
The latest statistics from the Department of Health also indicate general practice has a dose utilisation of 74% compared to an overall national rate of 81%. Some GPs have said they fear unused vaccines will go to waste, while others have said take-up for AstraZeneca remains high.
For Dr Diego Silva, a lecturer in bioethics at the University of Sydney School of Public Health, the obligation is clear, particularly if there is an oversupply at play.
‘If we are not going to use the AstraZeneca, we should absolutely donate it,’ he told newsGP.
‘To let it go to waste would be completely morally wrong, especially when healthcare workers in many other countries haven’t received their first vaccine doses.’
Prime Minister Scott Morrison committed to supplying 20 million vaccine doses to other countries at the G7 summit last month – with doses reportedly to be delivered by mid next year – and Australia has exported a small number to countries in the surrounding region. There is also a partnership agreement with UNICEF to procure up to six million doses for the Pacific region.
However, Dr Silva does not believe a wide enough view is being taken, a belief he qualifies by saying that Australia is far from alone.
‘You don’t hear Australian politicians talking about global solidarity much or what our obligations are more broadly,’ he said. 
‘This should not be seen as charity. There are intrinsically good moral reasons for sharing the vaccines; other countries are full of human beings … with basic human rights.
‘We’re not going to be fully safe until we are all safe. And if we would like to get off the island at any point, not only do we need to improve rollout, we also need to facilitate global rollouts more generally.’
Dr Gary Grohmann, a consultant virologist who has carried out work for the World Health Organization (WHO), agrees there are strong ethical and scientific motivations for exporting vaccines to appropriate age groups, but highlighted some of the technical challenges. 
‘The downside of the AstraZeneca is the 12-week gap compared to Pfizer,’ Dr Grohmann said. ‘That is significant.
‘You could obviously have an epidemic within those 12 weeks and if that occurred, people would only be partially protected. Pfizer is a three-week interval and that’s a lot better in terms of fighting a pandemic.’
He said that other vaccines – such as the Johnson & Johnson – would make it simpler still, with just one dose required.
Dr Grohmann also made the point that careful ongoing medical care needs to be factored into the COVID vaccination process overseas, with access likely to vary from country to country.
‘That’s something that must be taken into consideration. All these vaccines have some kind of risk – not just AstraZeneca – although it is vanishingly rare and treatable,’ he said.
‘If we can [supply] a whole lot of vaccines to the region, that would be a fantastic service to humanity.’
Sarah Joseph, Professor of Human Rights Law at Griffith University and Gregory J. Dore, a Professor of Epidemiology at the Kirby Institute at the University of New South Wales University, co-authored a paper published this week that covers the same theme.
Titled Vaccine Apartheid: A Human Rights Analysis of COVID-19 Vaccine Inequity, the article, which is not yet peer reviewed, described wealthy countries’ rush for vaccines as ‘probably ethically wrong’.
However, the authors argued it would be ‘difficult to characterise as a breach of human rights, given that vaccines fulfil the genuine human rights of their own populations, at least prior to the vaccination of the significant part of a state’s population’.
Once more vaccines than needed are available that dynamic shifts, the authors say.
‘However, blatant oversupply changes this assessment from non-breach to breach,’ they write. ‘Export blockages of vaccines or key vaccine components is a breach of extraterritorial obligations, unless it is motivated by an urgent need to provide for home supply.
‘Vaccine aid is a duty rather than mere charity, and must be given without unrelated conditions, either bilaterally or, preferably, via COVAX.’
Australia is expected to have a significant boost to supply by the end of October, with millions more doses from five separate vaccine orders scheduled to arrive.
Sydney GP Dr Ginni Mansberg said attaching blame for the expected oversupply of AstraZeneca is unfair, particularly as the issues with thrombosis with thrombocytopenia syndrome (TTS) became clearer after orders were made.
‘We have a perfectly good vaccine that could benefit a number of people,’ she told newsGP.  
Dr Mansberg believes the extent of vaccine hesitancy will only become clear later in the year and says there should be a further push to improve take-up, as RACGP President Dr Karen Price has consistently advocated.
‘Those who are not at all hesitant are making appointments and going off to the GP at the very first available opportunity to get whatever vaccine they can get,’ Dr Mansberg said.
‘There is a very large [vaccine-sceptic] group that will not become apparent until much later. That’s what’s happened in the UK, and those people are not doing well at the moment with the Delta variant.’
With excess stock likely, Dr Mansberg agreed other countries should be factored in.
‘Given we will have a very large oversupply of AstraZeneca, it seems like a good answer to help our Pacific neighbours, to give them a very good and effective vaccine,’ she said.
‘This virus will continue to be in the world, but also to mutate. If we want to protect all of our vulnerable Australians, then we need it to be gone in the rest of the world, too.’
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