covid 19 testing
(Image: AAP/Daniel Pockett)

The plan for Australia to truly “live” with COVID-19 as an endemic disease, rather than die with it, is taking shape.

Vaccination targets that will make widespread lockdowns less likely have been announced as part of the so-called national plan. And no doubt Australians look forward to living with greater freedoms.

But to do so requires thinking about what we need to do as we reach various vaccination targets, not only what we will be able to avoid — such as widespread lockdowns. So it was comforting to hear Prime Minister Scott Morrison say on Friday that the national plan involves vaccination and a range of sensible public health measures:

It isn’t just vaccination, public health social measures — the sort of things like distancing and things like that … that doesn’t stop when we hit 70%. People don’t stop getting vaccinated when you hit 70% or at 80%. It keeps going up and you keep having other sensible, commonsense precautions in place. Now if you do none of those things, well, of course you put, you put the community at great risk. But that’s not what the national plan suggests, and to suggest that that’s what the national plan is would be a complete misreading of that.

Vaccines-plus is exactly what the recently formed OzSAGE group advocates. By “plus” we mean testing, contact tracing and non-pharmaceutical strategies such as ventilation/filtration and masks. In the medium term these will be necessary to fight the Delta variant. And they may need to be scaled up or down in future depending on the severity of the epidemic.

Living with occasional outbreaks

It’s clear that COVID is here to stay, but that doesn’t mean we have to give up the very significant gains won in 2020. Even if we can’t eliminate it, we can control it.

At the moment this requires vaccines-plus and booster shots to maintain immunity within the community. The development of mRNA vaccines has been a spectacular achievement — but progress and innovation has not stopped with the advent of the current generation of vaccines. If anything it is accelerating.

In future we may well have vaccines that are even more effective than those available today. They might specifically target variants, or be designed to protect against a number of coronaviruses — a universal vaccine. Boosters or new vaccine products may provide longer-lasting immunity.

Leave no one behind

Vaccine targets should be met for all sub-groups of the population, and we must be cognisant of structural and social disadvantage. The groups include all Aboriginal and Torres Strait Islander people, residents of remote and regional Australia, and other high-risk and disadvantaged groups.

These groups are often more at risk of contracting COVID (due to participating in essential work, or living in crowded housing) and are at higher risk of having severe disease (due to higher rates of comorbid conditions or other clinical vulnerabilities). Yet because of challenges accessing quality medical care or lower levels of health literacy, they have lower vaccination rates. Unless more is done to ensure higher rates they are likely to bear the greatest burden of COVID when we start to “live” with the disease.

While vaccination is not available yet for all children under 12, we have outlined a series of steps to protect them and make schools safe while they await vaccination.

Protecting the health system

Australia has one of the best healthcare systems in the world. But COVID case numbers are already putting it under significant strain. This is true in New South Wales, where active cases are highest.

But the Victorian healthcare system is also under strain. More than 90% of ICU beds in Victoria are full; the impact of more patients needing ICU care due to community transmission will challenge an already struggling system.

OzSAGE plans to announce some strategies essential to preventing the loss of health workers and protecting hospitals and their patients in cities and regional areas.

2022 and beyond

As Australia reopens we need to do so safely and from a position of strength — we need to ensure that vulnerable people are not left behind.

Since the federal government acknowledged its missteps with buying and rolling out vaccines, vaccination has rightly received a great deal of focus. It is vital — but it’s not enough. It is necessary — but it’s not sufficient. Vaccination lays the groundwork for a more normal 2022 — but it doesn’t ensure it.