EXPERT REACTION: Aussie COVID vaccine rollout brought forward to February

This is excellent news. The international border is the greatest threat to us, because of new mutations of the virus which may be 50-80 per cent more transmissible than the current strain. One of these strains has become the main strain in the UK, and they are finding that the standard control measures such as social distancing are not working as well. If one of these strains takes off here, it may be more difficult to contain.

It is critical we vaccinate everyone working at the international border with the best available vaccine - not just hotel quarantine staff, but also transport staff, aircrew, airport workers. They are the most likely vectors of infection into the community - if they are well protected with the best vaccines, we can take a breath and wait for the broader community roll out. They need high efficacy vaccines like Pfizer or Moderna - the Astra Zeneca vaccine will protect them against death and hospitalisation, but may not protect well against infection - so they can still get infected and set off a community epidemic.

Protecting workers at the border is the most critical step to protect the community, and includes giving them respirators and finally accepting they are at risk of airborne infection. If the risk of community epidemics from the international border are reduced, we can wait for the population vaccination. 
Vaccination of health and aged care workers is also very welcome news.  

For general community vaccination, we should be getting the highest efficacy vaccines. I do not believe the Astra Zeneca vaccine based on published phase 3 trial results, will be efficacious enough for herd immunity. We must also be mindful that the key trial endpoint to assess is the prevention of any infection (not just symptomatic infection).

As I have explained here, I believe the elimination of COVID-19 in Australia may be feasible, if we use a high efficacy vaccine and vaccinate enough people. We should be aiming for this - we may or may not succeed, but we should try before resigning ourselves to living with COVID long term. Vaccines are the best exit strategy we have for COVID-19, but the choices we make today could take us down very different pathways, depending on those choices.

While many countries are in the midst of chaotic responses to widespread COVID-19 infections, Australia is in the enviable position of trying to stamp regional outbreaks and maintain COVID-19 free zones in other areas. Maintaining COVID-19 free zones allows for a more normal life and economic activity. A primary threat to regions that have been COVID-free for many months is the incursion the SARS-CoV-2 virus from international travellers. The best weapons against COVID-19 remain social distancing and masks, but vaccines offer powerful disease prevention tools, particularly for workers at international arrival and quarantine locations. 

Phase III clinical trial data from international studies suggest that several vaccines, including the Pfizer mRNA-based vaccine and AstraZeneca adenovirus-based vaccine, protect against severe disease. It remains unknown how effective these vaccines are at preventing transmission and reducing coronavirus in the community. However, statistical modelling efforts by Saad-Roy published in Science suggest that that vaccination may accelerate pandemic control even with imperfect vaccines and moderate vaccination rates. Vaccine rollout in the USA has been slower than planned, but Australia has a more tractable problem and the accelerated timetable for vaccine rollout for in Australia is welcome news to start 2021.

The news that certain priority groups will get the vaccine early should be greeted with cautious welcome.

This is a large complex program which requires careful planning, coordination, a well-trained workforce and an informed public. There are important logistical issues to consider. High-quality immunisation service provision is just as important as high-quality vaccines.

The Federal Government should be more forthcoming about the details of how they are planning this program and coordinating with state governments, so the public can be confident in the way this program will be rolled-out. We need to see much more proactive and frequent communication. Government may not yet have full knowledge of some aspects of the program prior to TGA approval but what is known and planned now should be communicated in more detail. 

Among the priority groups, it is good to see people with a disability and their carers included, along with those living in aged care.

The priority populations outlined by Prime Minister Morrison make sense and can be readily justified from various ethical viewpoints. Moreover, it is in keeping with the list from other jurisdictions, for instance, provinces in Canada, within the United Kingdom and the United States, with the exception of prioritising those who work with international arrivals, which makes ethical sense given Australia's situation. 

However what needs to be made clear is which group gets priority from within the aforementioned priority list (the 'rank', for lack of a better description), and on what grounds.

Premature approval of COVID-19 vaccines by Australia could have major negative public health ramifications. Current approvals in other jurisdictions are  Emergency Use Authorisations (EUA) and it is not clear from this announcement whether what is proposed is an EUA that restricts vaccine use to very specific populations or whether a more general approval is proposed, and if so, on what grounds? 

EUA’s are typically issued on a risk-benefit basis. Australia currently has minimal domestic transmission of the virus and hence the benefits of use of novel vaccines in this context has questionable benefit versus the unquantifiable risks. The absence of any data on the long-term effectiveness and safety of mRNA and viral vector vaccines makes any general approval of use of such vaccines questionable from a community safety standpoint. 

There remain major unanswered questions regarding the effectiveness of the mRNA and adenovirus vector vaccines. Currently there is no proof that any of these vaccines prevent virus transmission as opposed to just blocking symptoms of infection. Hence the risk is that such vaccines may just be making symptomatic infections, asymptomatic. This is a major concern as the use of such vaccines in workers dealing with international arrivals and quarantine could have the paradoxical effect of increasing the risk of further quarantine outbreaks into the Australian population with an infected worker thereby going undetected due to the vaccine suppressing symptoms if infected.  

Furthermore, receiving a vaccine may give such workers a false sense of security, making them more likely to engage in activities associated with higher risk of transmission to members of the community. It may also make them more likely to dismiss any mild symptoms as being non-COVID related. Similarly, disability workers and those living in aged care or with a disability are currently at low-to-no risk given the absence of community transmission. It is hard to justify immunising disability workers with vaccines that have unknown long-term efficacy or safety, given there is no evidence such vaccines are transmission blocking, which would be the only current major justification for their use in such individuals to prevent them passing on the virus to people in their care. 

While EUA of these vaccines may be perfectly justifiable in jurisdictions such as Europe and US where there is currently uncontrolled community spread of virus, with high morbidity and mortality rates, it is very hard to justify even an EUA of such vaccines in the context of the current situation in Australia, where instead it would seem to make more sense from a risk-benefit standpoint to continue to control any outbreak risks using proven quarantine, tracing and social isolation policies while awaiting stronger, longer term efficacy and safety data to be obtained on these vaccines from their use elsewhere in the world.

At Vaxine we remain committed to our development of our recombinant protein based COVID-19 vaccine approach with the aim to not only reduce COVID-19 disease but also to block virus shedding and transmission, as a safe and effective transmission-blocking vaccine remains the only viable strategy to bring this pandemic to a rapid end.

It’s good news that the start of the rollout of safe and effective COVID-19 vaccines has been brought forward in Australia. We should be beginning the rollout as quickly as the approval process allows, as the sooner we get started on this the more quickly we will achieve the health outcomes we want and the more confident we can be in moving all aspects of our lives forward.

We should bear in mind that the process of delivering the vaccine is a huge task and it is something that may perhaps take the remainder of the year to complete, and while COVID-19 exists in many places around the world in large numbers, we still need to have measures in place to protect us from the virus. However, the news that the vaccine is being delivered in several countries safely can rightly be viewed as a significant milestone in the fight against COVID-19.

This is a great step towards controlling COVID-19 in Australia. It’s important to note that while the logistics are being sped up, safety is remaining everyone’s top priority. We can be reassured by the approach that Australia’s independent Therapeutic Goods Administration is taking, as one of the most stringent regulatory agencies in the world. 

We expect the vaccine will be made available in a staged process in Australia, through targeted vaccination programs to the most vulnerable or at-risk people as determined by an expert committee. This is necessary given the first supply will be 10 million doses (enough for five million people) and considering the logistical challenges of distributing the Pfizer vaccine at -70 degrees Celsius.

For the rest of us, with more vaccines eventually available, we can hope to see more immunisations occurring through a staged process across Australia. These will become available to the general public as the year progresses.