What is needed to get Australians vaccinated by December?

When the Federal Budget was released on Tuesday one thing was clear – the figures are largely dependent on Australia reopening its borders in 2022, and as such are essentially tied to a successful vaccination campaign. 
 
While Prime Minister Scott Morrison subsequently said rollout predictions could be out by ‘many months’ either way, a new deal for 25 million doses of Moderna’s mRNA vaccine has left some experts cautiously optimistic.
 
Since the vaccine rollout commenced on 22 February, Australia has administered 2,894,770 doses, with more than 402,000 achieved last week alone – it’s biggest on record. Primary care remains core to these efforts, having delivered more than 1.65 million doses. 
 
Sydney GP Dr Michael Tam believes it is plausible that Australia’s target population could be vaccinated by December, at the very least with one dose, but says the rate of immunisation will need to ‘massively increase’.
 
‘The total number of doses administered on 12 May was roughly 82,000 of which the majority [50,000] was delivered in primary care,’ he told newsGP.
 
‘If we use generous round numbers for the current vaccination rate, [say] 100,000 doses a day, and consider that we have roughly 160 business days remaining in the year, that means that we can deliver roughly 16 million doses by the end of the year.
 
‘With the adult population being roughly 16 million people, we need 32 million doses. Conservatively, we’ll need to at least double the current vaccination rate to have immunised the Australian adult population.’
 
But for that to happen, Dr Tam says there are a few caveats, the key being a reliable supply of vaccines and logistical support.
 
‘For example, an online booking system that is functional and fit for purpose and supply of the necessary consumables to give vaccine doses at volume, [such as] appropriate needles and syringes,’ he said.
 
Queensland GP and Commonwealth vaccination centre clinical lead, Dr Kat McLean says while GPs have done incredibly well, that there is still a lot of ‘untapped capacity’.
 
‘There needs to be recognition and support for those GPs who have put up their hand and said we can do quite large numbers within a model that … they have planned and invested in,’ she told newsGP.
 
‘I certainly know of general practices that have said they can do 1000–2000 vaccines a week, and they’re getting 50.’
 
Currently Australia’s efforts equate to 11.6 doses per 100 people, compared to 32.3 in the UK, 28.6 in the US and 24.6 in Singapore at the same stage of their respective vaccine rollouts.
 
GP Dr Colin Fitzpatrick coordinated the vaccination program across 110 of Northern Ireland’s aged care facilities, where catastrophic outbreaks have since ceased. Now based in Queensland, he has observed a number of key differences in Australia’s approach that are stymying progress.
 
‘In [the] UK every general practice is vaccinating with few exceptions, as are most practices in the Republic of Ireland,’ he told newsGP.
 
‘In contrast, only a relatively small number of larger practices in Australia are vaccinating. GPs don’t see COVID vaccination as their number one task as do GPs in [the] UK.’
 
As people aged 50–70 became eligible to be vaccinated earlier this month, state governments have sought to ramp up capacity with more mass vaccination centres.
 
But Dr Fitzpatrick says in contrast to the UK, they are ‘few and far between’. With some practices still reporting months-long wait times for older cohorts, he believes regular communication between general practices and vaccination hubs would be useful.
 
‘I’m still on all the mailing lists [in Ireland] and almost every week there’s a discussion between GP leaders and the people running the vaccination clinics saying, “We’ve cleared the over 50s, but we’ve got a bit of a spare capacity, do you want to send a cohort to us?”,’ he said.
 
‘[They are] coordinating which patients go where, while closely monitoring demand and capacity.’
 
With Pfizer’s mRNA vaccine now the preference for those aged under 50, Commonwealth vaccine centres are set to be involved in its distribution.
 
While it remains unclear whether general practices will be involved, Dr Tam says to meet targets it will likely be a necessary step.
 
‘There is a significant possibility that the mRNA based COVID-19 vaccines, made by both Pfizer and Moderna, will increasingly be the mainstay of our vaccine strategy,’ he said. ‘The cold chain logistics, so that these vaccines can be delivered in primary care, needs planning now.’
 
Dr McLean agrees, and say it is an investment that goes beyond the COVID-19 pandemic.
 
‘The reality is that we’re likely to be utilising these types of vaccines for years to come and so equipping and supporting GPs to be able to deliver them [is important] and certainly possible … with the right support,’ she said.
 
Experts spoken to by newsGP agree that the vaccination program will need to be scaled up, one way or another, in order to reach the target. But Dr McLean says general practice’s impressive efforts to date demonstrate the trust and value in doctor–patient relationships, and says going forward the Government must address the shortfall in funding.
 
‘There really is a lot of pressure on general practice,’ Dr McLean said.
 
‘Particularly when we are having to spend long periods of time talking to patients, and almost inevitably a normal consultation now has questions at the end about COVID vaccines that are tagged on. So it really is a significant amount of work that GPs are doing.’
 
While the Federal Government has consistently attributed the failure to meet targets to logistics around supply, Dr Fitzpatrick says that is an issue every country has faced.
 
Rather, he says the main difference in Australia and the UK is the sense of urgency, ‘or lack of it’, an attitude he believes is a by-product of successfully keeping transmission low and a rise in vaccine hesitancy, further fuelled by the publicity around blood clot concerns.
 
‘There’s a real sense of urgency in Europe, the UK and Ireland that we’ve got to get this done now and stop COVID spreading. Whereas in Australia, quite frankly, a lot of people don’t believe COVID exists,’ he said.
 
‘Most people don’t know anyone who has even caught COVID. In contrast, most families in [the] UK have been infected and a large proportion have had deaths.
 
‘But as I’ve been trying to explain to my colleagues here, there is an urgency about it because sooner or later we’re going to open up travel – we can’t keep the country locked down forever – and COVID will appear, no matter how careful we are.’
 
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