- 2 years ago
30 June 2021
Listening to Chief Medical Officer Paul Kelly speak at the National Immunisation Conference (NIC) on Tuesday, I was somewhat amused by the written interpretation of his speech running across the bottom of the screen. The one phrase the computer was unable to understand was COVID-19.
The first time Professor Kelly used the expression, “curved in 19” was written on the bottom of the screen. The second time, “covered 19”.
In many ways, this was somewhat prophetic as indeed the decisions made by governments in response to the emergence of the virus, particularly in relation to vaccine deals, have determined whether the risk of infection has “curved” up or down, and to what extent populations are “covered”.
One such decision was made last year by the Australian Government in choosing which vaccines it would include in Australia’s arsenal. On paper, its shopping list made sense: one adenovirus vaccine from AstraZeneca (tick); one adjuvanted spike protein from CSL (tick); one mRNA from Pfizer (tick); and a protein subunit from Novavax (tick).
Chief Medical Officer Professor Paul Kelly revealed on Tuesday he didn’t expect even one of the vaccines to come through this quickly, never lone three of the four, so Australia – and the world – is indeed in a highly fortunate position.
But if we had the chance to rewind the clock and pick again, would Australia have chosen differently?
Well clearly yes. Hindsight is a wonderful thing and, unfortunately, the first vaccine to be struck off the list would have been our very own CSL/UQ candidate. Second, of course would now be the AstraZeneca vaccine due to the unfortunate rare clotting events associated with it. But these events, of course, have emerged much later in the vaccine rollout.
This week it emerged that, at some stage last year, the Federal Government made a choice between AstraZeneca and Janssens’ vaccines as both were viral vector vaccines from the same ‘family’. Both were being developed at a similar rate with one major difference – Janssen’s candidate required one shot while AZ’s required two.
Both companies had a strong local presence and were providing the vaccine at cost, with Janssen asking around $7.50 for its single-dose and AZ around $8 for two doses. The deal-breaker appears to have been that Janssen required a legislated, no-fault compensation scheme and liability protection.
“Our views are aligned with many experts in global public health. In all purchase agreements finalised to date, this has been addressed,” a company spokesperson told MedNews. “We do not comment on contractual negotiations but can say we have taken a consistent approach to achieve equitable access to our not-for-profit COVID-19 vaccine as we continue our global fight against the pandemic.”
In a sliding door moment last year, the Australian Government decided against providing a no-fault compensation scheme. This week, it introduced that very same thing.
Of course by now, the Janssen vaccine has been cursed by the same issues as the AZ vaccine and Australians have made it clear any vaccine with a risk of adverse events is on the nose, particularly when other (albeit expensive) options are available. When it comes to protecting ourselves in a pandemic, money is not an option for us picky Aussies.
But had Australia chosen Janssen’s one-shot vaccine over AZ’s two-shot, our vaccine rollout would today look very different.
Professor Kelly said on Tuesday just under a quarter of Australians had now received one Covid vaccine dose and only 4.5 per cent had received two. Had we taken up the Janssen option, one shot would have been enough for all of Australia’s aged care residents and people over 50 who had accepted the vaccine to now be fully immunised.
Discussions about vaccine hesitancy and a reluctance to have a second shot would be irrelevant. Everyone who had received a Janssen jab would be covered. So should the Government have just provided the indemnity Janssen had insisted on in the first place?
“Australia has been in contrast to 25 other countries including the US, UK, Canada and New Zealand in that it has not had a longstanding vaccine injury compensation scheme of this kind,” Public Health Association of Australia CEO Adjunct Professor Terry Slavin said. “It’s fantastic we are moving forward on this important issue.”
Australian regulators talk a lot about encouraging companies to apply for local registration of their products. TGA boss Professor John Skerrett has said on numerous occasions that Australia has worked hard to ensure companies register their products with the TGA.
In this case, Janssen has done exactly that. It has submitted its dossier on the same day as AZ, it has offered its product at cost and it has provided an advantage in that its vaccine required only one dose, meaning people would be covered three months earlier than if they had to wait for a second dose, as has occurred with the AZ vaccine.
The only difference was that Janssen required the Government to indemnify it and clinicians against adverse events, and to protect Australian citizens who suffered from such events. In the end, this is exactly what the Government has done.
If it had made this decision last year, our rollout strategy would today be very different, our ‘curved in 19’ would be trending down and around one in four of us would be ‘covered’. A missed opportunity? It appears to be so.