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Australia handled many aspects of the Covid-19 pandemic very well. Yet in mid-2021, Australia’s vaccine rollout was the slowest in the OECD. Richard Holden discusses why the policy errors reflected a failure to heed basic economic concepts of portfolio diversification and speaks to policy lessons concerning pandemic preparedness for Australia and other countries.

Image courtesy of interviewee. June 7, 2024

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This video discusses the disappointments and challenges Australia faced during its COVID-19 vaccine rollout, contrasting it with its overall pandemic response, which was deemed effective. The rollout was hindered by a flawed purchasing strategy that overly relied on AstraZeneca and a vaccine candidate from the University of Queensland, which was later withdrawn due to safety concerns. Consequently, Australia fell behind other OECD countries in vaccination rates, particularly early in 2021.

Once vaccines were available, Australia excelled in administering them, achieving high uptake and efficient distribution. The author stresses that the initial mistakes in purchasing could have costly economic consequences and emphasizes the importance of a different mindset for pandemic planning—prioritizing purchasing a diverse range of vaccines rather than minimizing costs.

The narrative also highlights the lessons learned, such as the need for sovereign mRNA manufacturing capabilities and a more integrated approach to public health that includes economics and interdisciplinary collaboration in decision-making. The author concludes that approaches to future pandemics should involve diverse expertise in advisory roles to address the multifaceted challenges presented by such crises.

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Australia's vaccine rollout was, was really,

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surprisingly disappointing.

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And I say surprisingly for two reasons.

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We handled many other aspects of the pandemic,

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actually incredibly well, arguably better than any other

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country in the world, in terms of being able to have

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shortcut, lockdowns, standup contact tracing

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and testing regimes very effectively

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and basically aggressively suppress the virus so

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that we didn't have the kind of outbreaks

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that you saw in the UK or Italy or the US or,

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or really many, many other countries.

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And we have a very high functioning administrative state,

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I think by most standards.

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So, you know, our healthcare system's very good.

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Um, you know, our government departments operate very well.

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So the vaccine, purchasing strategy

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and rollout, you would think would've gone well.

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Um, but it went poorly and,

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and it went at least, to start with

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and for a protracted period of time.

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And it cost us very heavily.

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And what basically happened was that we, instead of buying,

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all of the, say seven major vaccines, a good chunk

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of all of the seven major vaccines,

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because, you know, if you cast your mind back,

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nobody really knew whether the mRNA vaccines were gonna be

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as good as they actually turned out to be.

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Maybe viral vector vaccines were gonna be the thing.

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A lot of these were still in development.

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They were going through phase three clinical trials,

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and we bet really heavily on AstraZeneca

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and a candidate vaccine from the University of Queensland

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that was being developed in Australia.

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Um, and, you know,

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we put basically all our vaccine eggs in two baskets,

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and it didn't turn out very well.

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Um, it didn't turn out very well

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because the UQ vaccine actually tended to give people,

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false positive tests for HIV, so it had

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to be just withdrawn completely.

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So that was no good at all.

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And then we were completely reliant on AstraZeneca,

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and we hadn't purchased enough of the mRNA vaccines, like,

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like Pfizer and Moderna,

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and so we had to, we had to scramble late in the piece.

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And that really cost us very heavily.

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And, and as I and many others have argued, actually led us

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to having in, say, in the Sydney region

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and in other parts of Australia, a a three month

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to four month lockdown during the Delta wave that would've

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arguably been able to be avoided if we'd got,

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got onto our vaccines, in a more timely manner.

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Now we, in terms of once we actually had the vaccines,

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did we get the jabs into arms?

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That part we did Well, once we actually had the vaccines,

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it turns out state governments were very, very effective at,

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standing up these mass vaccination hubs.

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There was one, for instance, at the Sydney Olympic Stadium,

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and there were similar things in other, major centers,

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and, and Australians on the whole, certainly compared

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to, say the US Australians on the whole kind of have a bit

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of community spirit, like to do the right thing.

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Don't listen to vaccine conspiracy theories too much.

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So the takeup rate was really good.

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The distribution was really good.

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It was just the purchasing strategy

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that was a huge problem for us.

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As we've seen testimony at various, parliamentary

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and other hearings about it.

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What what it seemed really was just having the wrong

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mindset, which was to try and pinch pennies

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and say, you know, why would we wanna buy

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all these excess vaccines that might cost a lot of money?

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And of course, the cost benefit calculus

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during the pandemic was very different

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than during normal times.

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So I, I don't blame a purchasing manager in the Department

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of Health whose normal job is something like, you know,

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purchasing insulin, where if you can get, you know,

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a 3% better price,

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that's like a really important thing to do.

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Um, I, I, I blame, you know, people at the highest level,

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including the minister for not saying,

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this is not a time to pinch pennies.

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Firstly, if we've got excess vaccines we can give them to,

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you know, our Pacific partner, nations and so on.

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But also, you know, you, this is an insurance policy.

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You know, you buy insurance at times like this,

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and arguably the mistakes we made might've cost us 40

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or $50 billion in lost economic activity,

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let alone the human, the human cost of it.

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And so, you know, when we're talking about a, a,

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a few billion dollars that might've cost us 50 plus billion

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dollars, we just got the cost benefit calculus from,

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we were very, very slow to, to take off.

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So, you know, if one costs, our mind back

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or sort of looks at the data for, 2021

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for a good chunk of 2021,

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we were performing actually the worst

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of all OECD nations.

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Um, and we didn't even get

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to the OECD average in terms of the share

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of the population that was fully vaccinated.

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You know, it had the two shots, until October

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of 2021.

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So we were just miles behind.

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Interestingly, by the time, you know,

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once October had come about what I was saying

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before about our, ability to get jabs into arms,

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suddenly we were, we were performing the best in the OECD.

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So it was this real sort of, very, very slow ramp up.

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But once we actually had the vaccines in the country we're

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suddenly, you know, top of the pops basically.

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But it was that, it was those, nine

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or 10 months that were really so costly.

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I think one is to really internalize,

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deeply learn these lessons.

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Um, now I would like to think that the experience is,

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so obvi, the facts are so clear, the records so obvious that

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that, no health minister

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or government would, would make this kind of mistake again.

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Um, but you don't really know until you, you see it.

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I think one other thing that we learned,

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and there have been steps taken here,

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Um, i I is, is, is around mRNA vaccines

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and sovereign vaccine manufacturing capability.

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So we, we have learned from this experience,

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the Covid experience that mRNA technology

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is really pretty incredible.

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I mean, it's worth remembering that the mRNA vaccines were,

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in a sense invented in a weekend.

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'cause as soon as the genome was sequenced,

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you basically just all set to go.

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Now you have to do the clinical trials and so on.

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Um, but, that is clearly an incredibly powerful

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and important and, and superior technology.

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It also had, you know, higher efficacy

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and, you know, formed better apart from anything else.

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Um, Australia did not have during, the Covid period,

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any sovereign mRNA manufacturing capability steps have been

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taken by governments in Australia, state governments,

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in partnership with the Commonwealth to make sure

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that we, and partnering of course,

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with major overseas companies like Moderna,

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that we do have manufacturing capability here.

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It's not quite finished,

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but by the end of 2024, we should have the ability

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to manufacture in Australia.

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Um, and that will, give us the ability to know

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that we can do this onshore rather than having

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to worry about global supply chains competing

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with other countries and so on.

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And also be able to export those vaccines, you know,

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to the world, which would be an

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important contribution to make.

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Obviously the, the kind of medical research,

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which is incredibly important.

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And that's something I admire.

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But, you know, not equipped to, to do

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or undertake, but I feel

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that stuff's all been going very, very well.

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I think part of where we need to,

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be thoughtful about the research is really integrating.

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I, I think one of the things we learned from the pandemic

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was these things are not just public health problems.

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They're not just logistical problems,

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they're also economic problems as well.

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And one of the things that was useful was there were

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collaborations between epidemiologists and economists.

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Um, and, you know, effectively scientists,

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physical scientists during, the pandemic.

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I think making sure that we have that kind of,

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it's almost a cliche cliche these days

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to talk about interdisciplinary research,

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but really understanding

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that something like a pandemic is a multifaceted problem

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that involves, public health.

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It involves economics, it involves, physical science.

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And, and just thinking about that from the start

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and also making sure that some of our advisory committees,

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so the, the bodies like the Therapeutic goods administration

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in Australia, aren't comprised purely of people

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with expertise, in, say, you know, immunology

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or in, in health, but understanding

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that there are other perspectives.

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And, you know, I guess I would say this being an economist,

08:50.765 --> 08:54.245
but economics is an example of that, where having that

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as part of the perspective on, our advisory boards

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and our, bodies that are making decisions about when

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to approve vaccines

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and things like that, I think having that,

09:06.095 --> 09:07.605
broad perspective is really important.

"Lessons from Australia's Vaccine Rollout: A Critical Analysis of Strategy and Implementation"

00:00:00 - Australia's vaccine rollout was, was really, surprisingly disappointing. And I say surprisingly for two reasons. We handled many other aspects of the pandemic, actually incredibly well, arguably better than any other country in the world, in terms of being able to have shortcut, lockdowns, standup contact tracing and testing regimes very effectively and basically aggressively suppress the virus so that we didn't have the kind of outbreaks that you saw in the UK or Italy or the US or, or really many, many other countries. And we have a very high functioning administrative state, I think by most standards. So, you know, our healthcare system's very good. you know, our government departments operate very well.
00:00:47 - and rollout, you would think would've gone well. but it went poorly and, and it went at least, to start with and for a protracted period of time. And it cost us very heavily. And what basically happened was that we, instead of buying, all of the, say seven major vaccines, a good chunk of all of the seven major vaccines, because, you know, if you cast your mind back, nobody really knew whether the mRNA vaccines were gonna be as good as they actually turned out to be. Maybe viral vector vaccines were gonna be the thing. A lot of these were still in development. They were going through phase three clinical trials, and we bet really heavily on AstraZeneca
00:01:27 - that was being developed in Australia. and, you know, we put basically all our vaccine eggs in two baskets, and it didn't turn out very well. it didn't turn out very well because the UQ vaccine actually tended to give people, false positive tests for HIV, so it had to be just withdrawn completely. So that was no good at all. And then we were completely reliant on AstraZeneca, and we hadn't purchased enough of the mRNA vaccines, like, like Pfizer and Moderna, and so we had to, we had to scramble late in the piece. And that really cost us very heavily. And, and as I and many others have argued, actually led us
00:02:09 - and in other parts of Australia, a a three month to four month lockdown during the Delta wave that would've arguably been able to be avoided if we'd got, got onto our vaccines, in a more timely manner. Now we, in terms of once we actually had the vaccines, did we get the jabs into arms? That part we did Well, once we actually had the vaccines, it turns out state governments were very, very effective at, standing up these mass vaccination hubs. There was one, for instance, at the Sydney Olympic Stadium, and there were similar things in other, major centers,
00:02:49 - to, say the US Australians on the whole kind of have a bit of community spirit, like to do the right thing. Don't listen to vaccine conspiracy theories too much. So the takeup rate was really good. The distribution was really good. It was just the purchasing strategy that was a huge problem for us. As we've seen testimony at various, parliamentary and other hearings about it. What what it seemed really was just having the wrong mindset, which was to try and pinch pennies and say, you know, why would we wanna buy all these excess vaccines that might cost a lot of money? And of course, the cost benefit calculus
00:03:28 - than during normal times. So I, I don't blame a purchasing manager in the Department of Health whose normal job is something like, you know, purchasing insulin, where if you can get, you know, a 3% better price, that's like a really important thing to do. I, I, I blame, you know, people at the highest level, including the minister for not saying, this is not a time to pinch pennies. Firstly, if we've got excess vaccines we can give them to, you know, our Pacific partner, nations and so on. But also, you know, you, this is an insurance policy. You know, you buy insurance at times like this, and arguably the mistakes we made might've cost us 40

"Lessons Learned: Evaluating Australia's Vaccine Rollout and the Need for Interdisciplinary Approaches in Pandemic Response"

00:04:11 - let alone the human, the human cost of it. And so, you know, when we're talking about a, a, a few billion dollars that might've cost us 50 plus billion dollars, we just got the cost benefit calculus from, we were very, very slow to, to take off. So, you know, if one costs, our mind back or sort of looks at the data for, 2021 for a good chunk of 2021, we were performing actually the worst of all OECD nations. and we didn't even get to the OECD average in terms of the share
00:04:54 - You know, it had the two shots, until October of 2021. So we were just miles behind. Interestingly, by the time, you know, once October had come about what I was saying before about our, ability to get jabs into arms, suddenly we were, we were performing the best in the OECD. So it was this real sort of, very, very slow ramp up. But once we actually had the vaccines in the country we're suddenly, you know, top of the pops basically. But it was that, it was those, nine or 10 months that were really so costly.
00:05:33 - deeply learn these lessons. now I would like to think that the experience is, so obvi, the facts are so clear, the records so obvious that that, no health minister or government would, would make this kind of mistake again. but you don't really know until you, you see it. I think one other thing that we learned, and there have been steps taken here, i I is, is, is around mRNA vaccines and sovereign vaccine manufacturing capability. So we, we have learned from this experience, the Covid experience that mRNA technology is really pretty incredible. I mean, it's worth remembering that the mRNA vaccines were,
00:06:15 - 'cause as soon as the genome was sequenced, you basically just all set to go. Now you have to do the clinical trials and so on. but, that is clearly an incredibly powerful and important and, and superior technology. It also had, you know, higher efficacy and, you know, formed better apart from anything else. Australia did not have during, the Covid period, any sovereign mRNA manufacturing capability steps have been taken by governments in Australia, state governments, in partnership with the Commonwealth to make sure that we, and partnering of course, with major overseas companies like Moderna,
00:06:57 - It's not quite finished, but by the end of 2024, we should have the ability to manufacture in Australia. and that will, give us the ability to know that we can do this onshore rather than having to worry about global supply chains competing with other countries and so on. And also be able to export those vaccines, you know, to the world, which would be an important contribution to make. Obviously the, the kind of medical research, which is incredibly important. And that's something I admire. But, you know, not equipped to, to do or undertake, but I feel that stuff's all been going very, very well.
00:07:39 - be thoughtful about the research is really integrating. I, I think one of the things we learned from the pandemic was these things are not just public health problems. They're not just logistical problems, they're also economic problems as well. And one of the things that was useful was there were collaborations between epidemiologists and economists. and, you know, effectively scientists, physical scientists during, the pandemic. I think making sure that we have that kind of, it's almost a cliche cliche these days to talk about interdisciplinary research, but really understanding that something like a pandemic is a multifaceted problem

"Integrating Diverse Expertise in Pandemic Decision-Making"

00:08:21 - It involves economics, it involves, physical science. And, and just thinking about that from the start and also making sure that some of our advisory committees, so the, the bodies like the Therapeutic goods administration in Australia, aren't comprised purely of people with expertise, in, say, you know, immunology or in, in health, but understanding that there are other perspectives. And, you know, I guess I would say this being an economist, but economics is an example of that, where having that as part of the perspective on, our advisory boards and our, bodies that are making decisions about when
00:09:06 - and things like that, I think having that, broad perspective is really important.

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