Australia says no to AZ and J&J vaccines--vax rollout likely to be delayed by months

[Kokeshi123]

www.theguardian.com/society/2021/apr/13/australia-wont-buy-johnson-johnsons-one-dose-covid-vaccine-due-to-astrazeneca-similarities

I know quite a lot of Ozzies who are completely stranded outside their country due to the fact that they cannot keep small children within a hotel room for two weeks and pay a fortune for the priviledge. As it is, it's looking like Oz will not be removing its quarantine requirements until well into 2022 at the earliest.

I mean, I do think that a basic strategy of "(1) Hold borders tight with Zero Covid until the vax>(2) Unroll vax> (3) Open borders" is a sound one, but it does depend on the second and third bits of the plan actually happening...

"Otherwise we can have a thread about the reality of those with Aus / U.K. nationalities and what it means now and in the next few years."

This is the story I mentioned earlier Marsha, about the Aus minister saying that even whole country vaccination may not permit opening up. It is an interesting point - if vaccination is not 100% effective you cannot open up without the number of cases rising (although why doesn't supervised quarantine prevent this?? Is it just that there will always be some 'getting through?).

And an increase in cases may just not be politically acceptable. There may be a minority who want to open up travel for family reasons, but the majority may be more concerned to keep cases low/close to zero.

www.smh.com.au/politics/federal/international-borders-might-not-open-even-if-whole-country-is-vaccinated-greg-hunt-20210413-p57ixi.html

@MarshaBradyo

Since you can’t go back and you want to start now how long will you close borders for?

Definitely until we've fully vaccinated the majority (two doses, and third booster where required). At the very least until all vulnerable are fully vaccinated. There's including vulnerable to long covid so 30+.

Not completely closed borders. Obviously there's genuinely essential travel. We should temporarily stop all other travel (enforced properly, not by a half hearted probably waived on appeal £200 fine after the event) and put in place real quarantine.

"The UK and Ireland would have had to work together to close borders. It could have been done earlier for non-essential travel."

Yes, I wonder though whether Ireland would have been prepared to close borders to the rest of the EU, in a 'bubble' with UK, as early as Jan/Feb 2020 (just after 31 Dec 2019!). Hypothetical I know - as neither country was suggesting it.

Do people really think the repeated long lockdowns with the impact on mental and physical health, devastated businesses, 150,000 deaths (with a predicted 50,000 more), 1 million long covid cases is preferable to temporary closed borders and real quarantine?

I need to go and cook now but I guess I've had more than my fair share of a say on here!

"The point is that everywhere, every country in the world, should've temporarily closed their borders. The whole thing would've been over with pretty much a year ago."

Interestingly, I think one commentator did suggest that that might ultimately be the answer. It would be interesting to know what the result would have been if all countries had done that in December 2019 or January 2020.

As a side-question, does that then mean you can't test a vaccine - because there isn't enough infection anywhere to carry out enough testing? Does that then mean that you're in a stale-mate because you can't open up until there's a vaccine, but there's no 'pool' of people to test the vaccine on? Maybe those who know more about vaccine trials can advise!

I remember being lambasted for suggesting that all borders would slam shut at next pandemic - back when the WHO said not to.

We were very much listening to the central advice of the WHO back then.

Would I want the above to have happened yes great, but then if I could choose I’d get China to not let it out to start with, or maybe learn from SARS - keep going back if we want

I wouldn’t really want U.K. to be shut off now and in the future to all but a few countries, esp as they are not our neighbours though.

But mostly we have porous borders - take the hauliers you might not have many infections but it only takes one or two and a normal life spreads it fast. NZ only managed to do this by shutting down every time they found a case - and got the rest.

Anyway it’s a bit of a side bar to the Aus decision.

Definitely until we've fully vaccinated the majority (two doses, and third booster where required). At the very least until all vulnerable are fully vaccinated. There's including vulnerable to long covid so 30+

What are you avoiding in numbers (deaths etc)?

As after doing this you will still let in the variants you have avoided.

"But mostly we have porous borders - take the hauliers you might not have many infections but it only takes one or two and a normal life spreads it fast"

Yes that's one of the questions - with the number of exceptions we would have had to have, do you actually achieve enough for it to be worth it? (Essential workers being the obvious one, but also compassionate exceptions etc).

I suppose NZ and Aus must also have exceptions (though always with quarantine?) and yet have very few cases, so perhaps the same could have been achieved. Good point about the hauliers having very low positive rates.

As a side-question, does that then mean you can't test a vaccine - because there isn't enough infection anywhere to carry out enough testing? Does that then mean that you're in a stale-mate because you can't open up until there's a vaccine, but there's no 'pool' of people to test the vaccine on? Maybe those who know more about vaccine trials can advise!

I know very little about vaccine trials but I do remember reading that other countries (Brazil and South Africa?) participated in the AZ trials as transmission in the UK was too low (June 2020) to test efficacy. So I don’t know how you would proceed if there were no “hotspots” anywhere in the world.

Yes, it's an interesting paradox Mrs F - success in suppressing corona globally might have meant we could not reopen the borders ever!

I suppose in practice you then have to consider asking/paying healthy individuals to volunteer to be exposed deliberately to infection after they've received the test vaccine - maybe they're injected with the coronavirus? But there are ethical issues with that if there is no effective treatment for coronavirus.

(I think Edward Jenner did this with smallpox, but obviously that was a while back!)

Effing hell it’s nice to see the thread derailed by one poster. NOONE is suggesting that australia didn’t do the right thing in March 2020. We are suggesting they are not doing the right thing NOW in getting a vaccination programme done quickly.

Close the borders in December 2019?! it wasn't even clear at that point that the virus could definitely pass between people.

end December: identification of causal virus

start Jan 2020: genomic sequence of virus that would eventually (about end Feb) get the name SARS-CoV-2

January 2020: no asymptomatic infections had been documented yet; age as important risk factor for mortality or hospitalisation starts emerge.

February 2020: no one knew that CPAP was better than mechanical ventilation (yet). Asymptomatic/low symptom infectiousness just being documented. Isolation of infectious at distance from others still allows potentially infectious to go for a walk outdoors.

March 2020: NZ shut down the same week as UK... but at a point (in their prevalence of infections) that was ~equivalent to about 2 Feb in UK. Care home vulnerability just started to be documented. Infectious period after symptom onset starts to become clear (and therefore appropriate isolation period). Race as risk factor starts to emerge.

April 2020: PCR tests still very scarce & worldwide PPE shortage; no strong evidence in favour of mask wearing to prevent transmission. Superspreading events start to get documented clearly (not hysterical tabloid speculation). Occupational risk factors become established. Low risk of transmission outdoors becomes clear.

... identification of cheap steroids as effective treatment

... ~August 2021: first good meta-analyses of age-adjusted CFR.

.. identification as Long Covid as multiple syndromes, duration of persistence unknown

...There's so much we know now that wasn't known then.

If that had happened, there wouldn't have been a need for a vaccine. Worldwide temporary closed borders with real quarantine + short term domestic lockdowns would've got rid of it.

Threads go off on tangents sometimes Flyornofly it's a related topic because people started talking about how Australia's vaccine decisions might affect their border decisions.

So the hideously infective Kent variant hasn't hit australia yet. I can't imagine the chaos if and when it does. To keep it out means virtual isolation or vaccination programmes.

This is a disaster. Even the mention of 2024 puts an absolute dampener on the atmosphere, business, tourism, everything.

Is it a legitimate thing re the AZ? I can't accept that this is a well founded decision.

It was kind of too good to be true, that a super effective AND safe AND cheap vaccine could be produced so quickly. something was bound to give.

So back to actual question that doesn't get discussed calmly, whether all these covid controls are worthwhile. I gather most people think the sky is limit when it comes to covid control, Australia can do nothing wrong in trying to keep covid away. Not my problem. I don't live there... doubt I'll ever visit (especially now).

Could the decision possibly be motivated by supply issues? I know the EU blocked a delivery of AZ to Australia. Is there actually enough of it to give out to everyone there?

They set up their own manufacturing capability.

There doesn’t seem to be any general clamour for a vaccine in aus, so I don’t think it’s motivated by them trying to reduce demand. I’m very pro vaccine but I can perfectly understand the lack of motivation to get a vaccine if I were in aus without reason to want to open any boarder. This will be one of the challenges the government face I imagine. Motivating people to get a vaccine against a disease that is not a threat to them. Supply is not the motivation here in Denmark either, the (cowardly imo) health minister has said he basically doesn’t want blood on his hands. The liberal parties are now pushing to allow individuals to decide to go ahead and get the az outside government recommendations. It’s not motivated by supply because the doses are here already. The case number is so low the health minister I think is underestimating the level of threat from Covid but also the restrictions. Sorry another derail 🙂

@Tealightsandd

They've decided not to risk it. They've accepted it's safer to do zoom. I was just pointing out to those complaining about Australia's border restrictions that the UK's lack of restrictions also impacts families. The elderly parents are in London. Both fully vaccinated but vaccines are not 100%. I agree that hire car is the safest of the options but the risk remains, especially in London as it's the frontline for all new strains and a huge mixing hub. Our hotels are doing nothing like the Australian quarantine. The government has let in South African strain now. What strain next?

Did they use to never see these vulnerable elderly parents in flu season in case they'd picked it up on the plane or from a hire car?

@Tealightsandd
AZ is only around 62% effective (the higher rates of 70% were associated with the half dosing regime, which we didn't adopt). Pfizer and Moderna, especially if given on the 3 week schedule, are over 90% effective. We can see how well things are going in Israel, with the majority vaccinated (on Pfizer with 3 week gap).

This is not correct. The higher AZ efficacy came from spacing out the second dose to at least 12 weeks later. And the real world data is pointing to AZ being on par with the others for results.

twitter.com/thegazmanrants/status/1382369894096855043?s=21

"If that had happened, there wouldn't have been a need for a vaccine. Worldwide temporary closed borders with real quarantine + short term domestic lockdowns would've got rid of it."

I remember seeing a scientist say that for that to work you would have to eliminate every single case in the entire world, and that that was simply not possible (because some people have to go out in each country - medical care, retail etc, and some people have to cross borders - essential workers, etc). But I suppose if you suppressed it to very low levels and then every single country had very effective track and trace and isolate, it would be theoretically possible to keep it very low without vaccines for ever. Though I think the reality is that many countries would not be able to afford that level of track and trace, or to pay people to isolate - particularly for a disease which is perhaps less threatening to some countries than, say, malaria, tb (I don't know the relative figures)?

Anyway, that is side tracking from the thread, it is true! What newstart says is interesting - is it the case that many in Aus are not motivated to have the vaccine - if you don't want to travel, don't have family abroad, maybe your decision is to wait and see rather than have the vaccine immediately.

So what happens to the 700,000 doses of AZ that the UK sent to Australia last week during a month of massively decreased vaccination in the UK due to lack of supply?

Love the early coverage of events - wish more people knew this.

But a few points on what follows:

Mar 2020 "Care home vulnerability just started to be documented"?? I'm pretty sure it was in SAGE minutes from February when the plan was to let the virus rip through the UK population but protect the vulnerable. Despite protecting care homes obviously coming up then , it didn't get actioned until well into March which is one of the reasons why they were so badly hit in the first wave.

Also superspreading events were known about FAR earlier in the pandemic - the big one in South Korea occurred in late February. There was also the smaller case of the UK scout leader who picked it up in Singapore and brought it first to a ski chalet, and then to the UK - that was right at the beginning of February.

On things like masks and aerosol transmission, all that's changed is that a lot more western public health officials have conceded ground - but aerosols were considered significant last February as it was the only way to explain some of the superspreading events and there was precedent from SARS - also thought to spread widely in this way. Any lingering doubts should have been dismissed by the Skagit County choir practise event. Whitty (and by extension the UK government) just took a lot longer to accept the evidence because he's old skool and his ideas date back to a time when it was "coughs and sneezes spread diseases".

So really there's very little that we know now that we didn't know then.

What WASN'T known at the end of January 2020:
CPAP over ventilation - probably the most important breakthrough - also a number of other treatments that have proven effective.
Long covid - not that we know much about it now, but then we didn't know it even occurred.
Race as a risk factor

That's about it.

Obviously lots of refinement of evidence. You mention CFR - I presume you mean IFR as CFR has never been in doubt - I remember reading a paper published in January 2020 with the numbers broken down by age. But BOTH CFR and IFR have changed as medical treatment has improved and will change again as variants with different mortality rates take over.

Going back to the original point though - I was VERY suprised at the start of Feb that the WHO were not advocating international border restrictions/closures. Their message at the time was that these things were ineffective and would do more harm than good. I wonder if looking back, they regret making that statement.