Burnet Director and CEO Professor Brendan Crabb AC and Deputy Director Professor Margaret Hellard AM take a critical look at Australia's staged COVID roadmap in this commentary for Nine Media.
A plan for a phased exit from the lockdown-prone, closed border policy of Australia's aggressive suppression strategy was music to the ears of many Australians. Details were scant, but nonetheless, the Prime Minister's roadmap sets out an aspiration for exit that is appropriately cautious, staged and - crucially - based on epidemiological milestones, not dates. To determine what those milestones are the Prime Minister was explicit, Australia will rely on modelling.
The first phase of the roadmap is designed to buy time. Time to get vaccinated, time to get enough vaccines into the country to boost coverage, and time to model the scenarios that predict if it's safe to progress to the next phase of the plan. Buying time means returning to COVID zero and reducing the likelihood of further lockdowns by addressing leaks from hotel quarantine.
It buys time to "review the national hotel quarantine network"; we hope this includes reviewing the national standard to mitigate against airborne spread in quarantine and in the community.
The current aggressive suppression strategy that underpins COVID zero has served Australia very well on all fronts and is easily the best option while we are building vaccine coverage and ongoing public health defences. It is the only safe, economically smart, and socially relatively open option for the moment. But it cannot and should not be Australia's long-term plan. So how do we move beyond this point?
The cornerstone of the roadmap is of course to achieve high levels of vaccine coverage. With 26 per cent of Australian adults currently saying they don't intend to get vaccinated, and children under 16 not included in the current vaccine strategy (another 15 per cent or so of the population), achieving very high population coverage will be challenging even when availability is less of an issue.
Some current modelling suggests that even with high vaccine coverage, "herd immunity" to stop transmission, illness and death from COVID-19 will only be possible with the addition of public health interventions. The level of vaccine coverage required will vary depending on vaccine efficacy against the different variants of the COVID-19 virus circulating in the community.
Importantly, even with high levels of vaccine coverage, there will be a group of people in whom the vaccine did not work, or who were unable to be vaccinated, who will not be protected. In addition to vaccine hesitancy, many people remain unvaccinated because of difficulties accessing the vaccine.
Even with high levels of vaccination, it will be vital that people continue to test regularly for COVID and quarantine until they have their test result. Also, on occasions, it is likely that restrictions will need to be introduced to stop large outbreaks in the community, especially with the emergence of new variants in the future. Further modelling is needed to understand the timing of when to introduce restrictions and the level required to maintain control.
Another critical issue is the management of Australian citizens and residents returning to the country from overseas travel. Again, models suggest that simply opening the borders will not be possible; there will be a need for ongoing border quarantine controls.
However, the type of quarantine will vary; with improved community vaccination levels and vaccination of people returning to Australia, home-based quarantine will be possible for some people while others may need to stay in purpose-built government-controlled quarantine facilities.
This might vary depending on the prevalence of COVID-19 in the country from where the person has travelled, the countries they transited on their trip home and if they have been previously vaccinated, when and with what vaccine.
Apart from Australian residents returning home, COVID-19 border restrictions have had a significant economic impact with reductions in international students and skilled and non-skilled migrants entering the country. A similar thoughtful approach is required to ensure these groups can travel to Australia without putting the community at risk.
While much remains to be determined and many hurdles remain, starting this discussion at a national level, led by the Prime Minister in collaboration with the state premiers, is a significant step. It signifies an ambition to safely reopen in a way that, if continued, has the potential to be nationally galvanising.
With all we will learn from overseas, and with all we know about the effectiveness of public health measures here and elsewhere, Australians should be confident that an appropriate 'Vaccines-Plus' formula can be found in the coming months. One that builds on the back of high vaccination coverage to involve judicious use of public health measures such as masks, home testing, home quarantine for some and purpose-built quarantine for high-risk travellers that mitigates against airborne transmission.
It may be many years, if ever before we return to our pre-COVID lives, but this plan offers the opportunity to live life in a way that COVID-19 does not dominate every daily conversation and decision while keeping Australian's safe from the worst pandemic pathogen in over a century.
