Australia’s current COVID-19 vaccination scheme continues to lag behind our contemporaries in the UK, Europe and the US. As of May 7th, only 3.9% of Australia’s population had received their second COVID vaccine dose. While much of the blame may lie supply side, with the failure of the AstraZeneca vaccine and logistical inefficiencies between various health departments, another potential bottleneck may be the method Australia is employing to distribute its vaccines. 

Given the recent ‘soft reset’ to our vaccination program, it may be worth looking at whether we can optimise the prioritisation of individuals to ensure the quickest uptake of the vaccine and the subsequent protection of the population. 

Purpose of vaccinations:

To begin to answer this question, we must first broadly look at the two goals of vaccination.

• To reduce severe responses to a disease – ideally to avoid serious complication and hospitalisation.

• Vaccinate enough people to break the chains of transmission (herd immunity).

Australia’s vaccination prioritisation at the moment, as noted on the health.com website, is in service of the first goal. Groups have been organised from most vulnerable to least vulnerable, with those working with the most vulnerable included in the earlier groups.

However, Australia is currently a fairly COVID-free country, with almost no recent instances of hospitalisations. Furthermore willingness of the public to accept snap lockdowns over a handful of cases further confirms that we, as a community, wish to keep this status quo. As such, any vaccination policy should aim to achieve herd immunity as quickly as possible, and in the intermediate time, ensure that as many routes of transmission are sealed off when the virus leaks into the community.

Fairness, but for whom?

One way or another, herd immunity will be achieved, but the effectiveness of the intervening time is the crux of this question. Phases 1a and 1b, which cover healthcare workers, hotel quarantine workers as well as elderly and aged care residents are common sense and are an appropriate use of a limited resource.

Beyond stage 1, however, things become a bit more unclear. Does a COVID-19 vaccine have more utility, defined here as breaking chains of transmission, if given to a recent retiree  (stage 2a) over a mid-30s professional (stage 2b) or a 16-year-old, Year 10 student (stage 3)? I argue that by the time the vaccine rollout reaches the greater adult population, any utility of the former prioritisation scheme disappears. For example, while a 75-year-old male is at greater risk of hospitalisation due to COVID-19, statistically speaking, they are also more likely to be out of the workforce and not travel a great deal on a day-to-day basis. Therefore they should be less likely to be exposed or a driver of transmission. Conversely, a young person working in the service sector, while less likely to get a severe illness, is more likely to be exposed to many people and travel around, thus being a driver of transmission in the community.

Data from international sources and the Melbourne lockdown show that, at least initially, the progression of COVID-19 was driven by young people with mild illness. This makes the case for actually reversing the current prioritisation groups.

An Alternative Model:

Ultimately, breaking chains of transmission is a numbers game, which has to involve ramping up our vaccination rate and dispersing it more greatly throughout the community.

A potential alternative model to our current program might be ‘first come, first serve’ (FCFS) system that has been deployed in several US states and parts of the EU to decent success. Practically this would see stages 2 & 3 rolled into one and vaccinations given to anyone in the adult population who wants one. The most immediate benefit would be that vaccinations are more evenly dispersed through the adult population, especially to those who are more likely to be exposed due to their jobs or day-to-day living. Such a program may also overcome other bottlenecks in the vaccination program:

Additional Benefits

• Clearer Distribution

Australia’s vaccination distribution is bit like a Kroonenberg monster at the moment. The Feds, States, GPs, Hospitals and private companies all have some hand in delivering the vaccine to different groups. Individuals are, rightfully, confused on exactly where and who will be giving their vaccination.

Opting for a FCFS system should simplify this process; everyone is now eligible for the vaccine; Therefore, the process needs to be centralised. Ideally, this would be within hospitals and potentially mass vaccination centres, as seen overseas.

• Clearer Communication

Additionally, an FCFS system is a straightforward public health message to sell. ‘Come and get vaccinated when you are available’ – no faffing about with SMS notifications or missed doctors calls to tell you that you are now eligible.

• Less vaccine wastage.

Vaccine wastage is a real concern. At the moment, it isn’t too much of a problem given the limited scope of stage 1/2 vaccinations. However, as the pool of eligible people increases, so too will the rates of wastage. Currently, if an individual misses a vaccination appointment, the onus is on the provider (GP, company, etc.) to find an eligible replacement; if one isn’t found and the vaccine left out for too long, it is spoilt. Worst still, if this is the first dose, then a second dose is also lost since it is current Government policy to ensure that there is a matched supply for two doses.

A FCFS system negates this problem; if someone misses an appointment, you can offer it to the next person since all adults would be eligible. This should dramatically reduce rates of wastage.

It is unlikely that the government, with its resources now invested into the current prioritisation scheme, will change tack; however, that should not stop us from questioning the efficacy and rationale of the present system. One ‘elephant in the room’ noticeably absent from my argumentation is the current vaccine supply, particularly of the Pfizer version, available to Australia. This is a complex topic beyond the scope of this article. Still, regardless, neither the current strategy nor a FCFS scheme will work if vaccine supply continues to be restricted and undersupplied. Let’s hope that these early bottlenecks are resolved soon as we look forward to a much more open and more unrestricted 2022!

Pravind Easwaran is a member of the Sydney University Conservative Club