The Premiers gambit NSW looks to vaccine escape hatch

It’s been the story of this pandemic so many times before: the sun breaks through, then the clouds roll in again.

So it was at the end of this week. Just as the NSW government was gaining traction with its message to all adults, 18 and over, to get vaccinated promptly against COVID-19 â€" and not to hesitate over AstraZeneca â€" news came that must have left the state’s senior health officers with their heads in their hands.

Premier Gladys Berejiklian insists “we have the harshest lockdown conditions that any state in Australia has seen”.Credit:James Brickwood

A young woman, just 34, died from an exceedingly rare blood-clotting disorder linked to the vaccine â€" only the sixth Australian to do so from more than 6. 8 million doses of AstraZeneca administered in this country.

Utterly tragic as her death was, health authorities are desperate to keep the public mind focused more on the state’s mounting toll of death and disease from COVID-19, hoping this will drive vaccine uptake â€" the jab seemingly now the only ray of hope on NSW’s horizon.

Sydney’s Delta outbreak continues to smoulder at a frustratingly irrepressible rate. Thursday’s figure of 262 new cases was a new high, eclipsed by Friday’s 291.

And the victims are not just the elderly. On Friday 58 per cent of new cases reported on Friday were under 30. Intensive care units are seeing patients in their teens, 20s and 30s. Earlier in the week, a 27-year old man died from the disease while isolating in his south-west Sydney home, the state’s youngest COVID-related death to date.

Premier Gladys Berejiklian, chivvied daily by journalists about whether she’ll tighten the lockdown screws even further, insists “we have the harshest lockdown conditions that any state in Australia has seen”.

“The vaccine is our key tool”, she says, jarring with the Prime Minister’s assertion that the lockdown itself is “the primary tool”.

This week the core message from senior NSW ministers and chief health officer Dr Kerry Chant has been for the public to get behind a state-wide effort to achieve 6 million jabs (first or second doses) by the end of August, which will equate to roughly half the state’s population.

To reach the 6 million goal, every delivery channel available to state and federal authorities is being ramped up. Just under 4.3 million doses have been administered in NSW so far, of which about 2.7 million have been delivered via Commonwealth channels which include GPs, specialist respiratory clinics, and aged and Indigenous health care.

The NSW government has been responsible for delivering the balance, around 1.6 million doses, through outlets which include three mass vaccination hubs at Sydney Olympic Park, Lake Macquarie, and Macquarie Fields in Sydney’s south-west, with two more mass hubs due to open at Wollongong and the Qudos Bank Arena on Monday. To bolster the vaccine workforce, appropriately trained student dentists, podiatrists and speech pathologists among others are being brought in.

People wait in line at the mass vaccination centre at Sydney’s Olympic Park this week. Credit:Wolter Peeters

Local authorities are also pumping out vaccines via another 40 or so NSW-run clinics around the state, and through 100 “outreach” locations (where metropolitan-based medical teams fly to rural areas on set days to administer jabs).

In the hotspots of south-west Sydney, pop-up and walk-in vaccination clinics targeted heavily at multicultural communities are now operating on set days a week at places like mosques and community centres, with a key walk-in clinic operating seven days a week at Prairiewood.

The head of the federal government’s Operation COVID Shield, General John Frewen, has proposed adding drive-in clinics to the mix, a move which caught the state government off-guard when it was announced mid-week.

But NSW Health Minister Brad Hazzard told the Herald he welcomed the initiative and “encouraged” Canberra to work with the state on determining the best locations, while “preferably getting on with it as fast as possible”.

He’s also welcomed federal help in getting vaccine programs into south-west Sydney’s major distribution hubs for suppliers such as Woolworths, Coles, Aldi and Metcash.

”If a shop closes down there is always another shop. But taking out a distribution centre would be a disaster” Hazzard says.

So far 21 per cent of the state’s eligible residents have been fully vaccinated, including 45 per cent of over-70s. Between April and the end of July, 2.53 million of those jabs were AstraZeneca and 1.51 million Pfizer, with the vast bulk of the AstraZeneca going out through federally-run channels. However one in five over-70s have yet to even receive a first dose, which Chant says is of grave concern.

For the state to reach its 6 million target by month’s end, around 69,000 doses will have to be put into arms daily, a tall order given that weekends usually dip to around half the weekday rate. Yet it would seem within reach if NSW keeps up the pace of more than 80,000 doses administered every day this week. On Wednesday the figure exceeded 84,000 doses.

GPs are doing a substantial proportion of the heavy lifting, with 1800 of the state’s almost 3000 general practices participating in the program. Many small practices however are turned off by the costs and staffing demands of the consent process, reporting requirements and a delivery protocol which requires the observation of patients for 15 minutes after each jab is administered.

“GPs get a rebate $31 from Medicare for every first jab, then it drops to $24 for the second,” Mount Druitt GP Kean-Seng Lim told the Herald. “It can be financially non-sustainable for many doctors”.

“For normal vaccines it’s pretty simple. But with AstraZeneca the consent process is significantly longer. This is not like giving the flu vaccine.”

The latest weapon to be added to the vaccine armoury is pharmacies, only now gearing up despite many having engaged with the federal government’s “expression of interest” process back in March.

Across the state 1250 pharmacies have been authorised to join the program, though only around 300 have started inoculating customers and just 56 pharmacists were listed this week as vaccine providers on the NSW Health website.

That number will climb swiftly next month, as hundreds more join the rollout. NSW pharmacy Guild president David Heffernan says “we’ve been ready to go from day one â€" it’s just been the block of government”.

Port Macquarie-based pharmacist Judy Plunkett says the vaccine rollout has been “singularly the most frustrating thing in [her life] for the past six months”.

“If pharmacies were brought on in April we could have done tens of thousands of doses by now,” says Plunkett, who has given out 4000 flu vaccines this year. ”Every barrier has been put in front of us.“

Plunkett adds that many pharmacists are uniquely connected to their communities and well-placed to help long-standing customers who might struggle with impenetrable booking systems and consent process.

“The booking system is a mystery to most people. It’s not accessible. It’s not easy. And it’s not selling itself. These are all people who often don’t have cars and many have carers that bring them in to see me. They are saying ‘Judy we will wait for you to vaccinate us’.”

At his family-owned Priceline pharmacy in Fairfield, pharmacist Quinn On has been staggered by the demand for the vaccine since he started administering AstraZeneca on July 26.

Having erected a gazebo on the pavement outside in order to keep patients socially distanced while he explained the vaccine process to them, Quinn discovered he and staff were attracting quite an audience among local Cantonese, Mandarin, Vietnamese and Lao speakers (the pharmacy’s staff are multilingual).

“During the day we started noticing everyone was hanging around listening to us, as we counselled people over the consent form and explained the risks and benefits of AstraZeneca. We managed to debunk a lot of the misinformation because many don’t speak much English,” Quinn says.

“We went from doing 25 on the first day, to 172 on the third day.”

He rapidly exhausted his government-allotted quota of 300 vaccine doses for the fortnight and had to borrow extra from a local GP and another pharmacy. He’s now won agreement to administer 600 a fortnight, but could do more.

Cabramatta pharmacist Quinn On runs two pharmacies, both offering walk-in AstraZeneca vaccine shots. Credit:Dean Sewell

Quinn says for some of his peers the $19 paid per jab has been a deterrent, given the higher Medicare rebate paid to doctors. Quinn finds the payment does not cover his costs. “But I say ‘do it for the community â€" the more people we can do the quicker we can get out of this’.”

His experience highlights how effective local leaders can be in countering misinformation about the virus, which has seeped into Sydney’s most vulnerable ethnic communities from overseas media and eroded confidence in vaccines.

Data from Operation COVID Shield revealed for the first time this week the glaring “vaccination gap” between some of Sydney’s most privileged areas, and the hardest-hit south-west. More than a quarter of those aged over 15 living in North Sydney, for instance, are fully vaccinated compared with just 14 per cent in the south-west.

As well as being the epicentre of the city’s outbreak, the south-west is home to many of the key “authorised” workers who must leave the area daily to provide essential services such as aged care and food distribution.

Public health experts say lack of easy access to vaccines, constrained supply and complex booking systems have been to blame, with younger people â€" who predominate in the south-west â€"locked out of AstraZeneca until very recently because of changing advice from the expert ATAGI advisory group. They’ve been denied Pfizer because of lack of supply.

In the Hunter and Newcastle, now under tight lockdown for a week, there are also low rates of vaccination. In the Hunter only 14 per cent are fully vaccinated.

On Thursday Berejiklian announced a fast-tracked 180,000 Pfizer vaccines would be provided to NSW in the next fortnight, news which the premier said had left her and her health officials “overjoyed”.

Yet federal sources later confirmed these were the same jabs that had been foreshadowed by the prime minister on July 25.

The top-up comes after Canberra sent an extra 300,000 doses earlier in July â€" half Pfizer, half AstraZeneca - to boost jabs available for south-west Sydney. The Pfizer doses were used almost immediately on teachers and aged care workers, and state authorities asked the federal government to direct the AstraZeneca doses to community pharmacists instead of state hubs. Hazzard warned that thousands of appointments had not been taken up due to ATAGI’s changing advice on AstraZeneca.

Chief Medical Officer Professor Paul Kelly, COVID-19 Taskforce Commander, Lieutenant General John Frewen and Prime Minister Scott Morrison at Parliament House on Friday. Credit:Alex Ellinghausen

But in July NSW administered 773,976 AstraZeneca doses compared to 325,086 in April. The message from local health authorities now is unambiguous: if you are 18 or over, don’t wait â€"take whatever is available.

From September the state should start to receive at least 290,000 Pfizer doses each week, together with 30,000 Moderna and at least 300,000 AstraZeneca. “We can provide as much AstraZeneca as people request right now,” Frewen said this week. Anthony Albanese has proposed a $300 cash incentive, a measure the prime minister has been quick to dismiss, but some form of carrot to shift the doubters may prove necessary down the track.

Berejiklian has dropped veiled hints at minor loosening of the straitjacket once the state hits 6 million jabs. But the weight of epidemiological evidence leans heavily against that prospect.

Modelling carried out by the Doherty Institute for national cabinet makes clear vaccination rates have to reach around 70 per cent, at least, before any meaningful easing of restrictions can occur without a resurgence of the highly infectious Delta strain. And even at 70 per cent, effective testing, tracing, isolation and quarantine has to remain in place. An Infectious Diseases Society of America briefing this week painted a bleaker picture, arguing that Delta has pushed the threshold for herd immunity to well over 80 per cent and potentially approaching 90 per cent.

Frewen has promised that every Australian who wants a vaccine will have the chance to get one by Christmas. By then we may have exceeded the 70 per cent national vaccination uptake. It’s anyone’s guess what stomach the community will have for compliance with on-and-off lockdowns by then.

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Deborah Snow is a senior writer for The Sydney Morning Herald.

Lucy Carroll is a reporter covering health for The Sydney Morning Herald.

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