It’s not entirely clear how encouraging words cleared the gritted teeth of the New South Wales health minister, Brad Hazzard, this week, but he managed it.
The precursor to Hazzard gritting his teeth was Scott Morrison dropping a statement to media outlets on Tuesday night declaring the national cabinet would resume meeting twice a week to deal with the mess of the vaccination rollout.
Morrison was rewarded with amplifying headlines on Wednesday morning about the country returning to a “war” footing – whatever that meant. It was unclear whether Australia (led by new defence minister Peter Dutton) intended to invade Europe and storm the factories of Big Pharma to commandeer some jabs, but in any case, Hazzard responded to his conscription to national service by observing that collaboration across the jurisdictions was welcome.
Previously, Hazzard thought, when it came to the vaccination program, decisions had “largely been a one-way street, with states and territories being told that this is how it is going to work”. The minister kept rolling. “That hasn’t worked so well so far, so maybe it’s time to have a rethink”. For good measure, Hazzard also noted “vaccine rollouts are state and territory core business”.
If you aren’t fluent in the passive-aggressive dialects of commonwealth-state relations, this short homily from Hazzard could be a little opaque.
So let me spell this out.
According to well-placed people who have been involved in the management of Covid-19 since the beginning, the states and territories (and some other experts) have been telling Morrison and the federal health minister, Greg Hunt, for months that their preferred mode of rollout of coronavirus vaccines carried significant downside risks.
Objections from the states and territories have been expressed at the level of health and treasury ministers. Premiers and chief ministers have also raised the risks at national cabinet. As one person put it to me candidly this week: “We’ve been watching this slow-moving train wreck right from the beginning.”
There are two main issues: the design of the vaccination program, and decisions about procurement.
When it comes to the design of the rollout, at issue is Morrison and Hunt’s decision to have GPs and pharmacies deal with the jabs as “critical partners” rather than handing over the program to the states to manage.
If you ask around the government why this decision was made, the explanation you get is simple. GPs and pharmacies are politically influential and seen as largely friendly to the Coalition (community pharmacy in particular). People say Morrison and Hunt saw political benefit in a successful national vaccination program being run by friendly health groups, and this was preferable to having to run the gauntlet of the states and their endless naysaying and nitpicking.
This Canberra-led delivery model would enable Morrison and Hunt to own the success of the rollout and sail forth in triumph to the federal election.
People say nobody seemed that focussed on the political risks of owning a debacle, even though the potential for that seemed reasonably high, given the number of moving parts and vagaries outside the control of the Morrison talking points complex.
In fairness to the prime minister and his health minister, there are practical benefits with their preferred delivery model. GPs obviously know their patients, and the established trust relationship between doctors and patients can assist with countering vaccine hesitancy, particularly with vulnerable cohorts. So there are pluses.
The problem is there are also a number of minuses. GPs can’t run a mass rollout if they are running a normal clinical practice as well. Vaccinations can’t proceed fast enough. I gather it was also pointed out to Morrison and Hunt that as well as the preferred model being comparatively inefficient, a rollout configured that way would also be more expensive.
Having unpacked that, let’s move to procurement and supply issues. Obviously, it is supremely bad luck that the AstraZeneca vaccine has been the jab that has run into complications. But experts in this area are emphatic the commonwealth didn’t do enough to hedge against the risks.
People say the government was advised the United States, through operation Warp Speed, was hoovering up enormous amounts of supply, as was the United Kingdom – two countries trying to manage mass infections. So realpolitik demanded that Australia needed to pay what was necessary, diversify the deals, and get into the global supply queues as fast as possible.
The US and the UK were investing in vaccines and signing supply deals in May and June of 2020. That race reflected the realities of surging demand and limited global manufacturing capacity. But again, people with knowledge of the deliberations say the government effectively lost the supply race between June and August of 2020.
When you ask why that was the case, you’ll hear the federal health department is bloody hopeless, or the government was first preoccupied with a local vaccine candidate being pursued by the University of Queensland, which turned out to have problems, and was then far too slow in chasing and locking in supply from other manufacturers.
What looks like extraordinary lethargy in the government’s actions was masked by regular government assurances about Australia being “at the front of the pack”. This was, to put it mildly, complete bollocks.
So now, the governments of Australia are back to the drawing board, with national cabinet meetings scheduled twice weekly.
While the states and territories are likely to approach this process constructively, not because they are saints, but because the governments and the citizens of Australia really need the national Covid vaccination program to work – there is some concern that Morrison’s new whip cracking timetable is configured around the need to feed the media cycle rather than serving the imperative of clear headed deliberation and decision making.
There is also concern behind the scenes that the “war footing” could also be a not very subtle attempt to muddy the waters about responsibility and accountability. It’s worth unpacking this blame-shifting point a little.
During the pandemic, the commonwealth has led the economic response. The fiscal measures haven’t been perfect, but the proof of broad-ranging success is there in the strength of the nascent economic recovery. So Morrison, Josh Frydenberg and the Treasury secretary, Steven Kennedy, get an elephant stamp.
The states have basically run the public health response, and can absolutely take credit for where Australia stands today in terms of effective infection suppression.
On the health side, the Morrison government had only two significant responsibilities (apart from biosecurity regulations including closing the international border and general coordination). The first was safeguarding aged care (and we know how that went) and the second is the vaccination program – which has been characterised by flawed decisions and some bad luck.
During the aged care crisis in Victoria, Morrison engaged in overt blame shifting with the Victorian government. Even though the commonwealth is demonstrably the prime mover in aged care, the funder and the regulator, Morrison insisted Victoria was also in the dock when Covid infections entered nursing homes because the state government failed to stop community transmission of infections.
Morrison’s “pox on all our houses” strategy paid some dividends back then, according to the Guardian Essential poll. When asked last August to identify who was to blame for the outbreaks in aged care during the pandemic, slightly more respondents identified the state government (30%) than the federal government (28%) – and more people blamed the aged care providers (42%). Nobody is responsible if voters can be persuaded that everyone is.
But the latest Guardian Essential poll published this week indicates voters are fully aware that Morrison and his government are the prime movers in the national vaccination strategy. The poll showed just over half of respondents believed they were being vaccinated more slowly than they would like, and nearly a third (27%) of the sample felt vaccinations were progressing a lot more slowly than they would like.
Voters were asked to identify which tier of government or what factors were most responsible for problems with the vaccination rollout from a list including Canberra, the state governments, international supply chain problems, and unavoidable production delays. Canberra topped that list, with 42% of the sample identifying the Morrison government. Problems with supply chains and production were next (24% and 18%). Only 7% of the sample thought the states were responsible.
Morrison will need the cooperation of the states to overhaul his botched vaccination strategy and make sure that the mass inoculation program can proceed as quickly as possible once the extra doses of the Pfizer vaccine reach our shores, hopefully in the fourth quarter of 2021.
Let’s hope the prime minister can control himself sufficiently to avoid a repeat of the aged care blame game, because I strongly suspect the voting public, fatigued with a pandemic that never ends, and looking at the prospect of another winter without the cover of a Covid vaccination, are in no mood for it.