International travel by early next year, permission to quarantine at home and a traffic light system to define high-risk countries should be part of a plan to reopen Australia to the rest of the world, according to experts who spoke to Guardian Australia.
Frustrated by the lack of strategy from the federal government about how and when border restrictions could be eased, the president of the Australian Medical Association, Dr Omar Khorshid, has said the government could open international borders early in the new year if it made vaccines mandatory for anyone wanting to travel.
He said it was possible to begin work on a strategy now based on independent medical advice that prioritised the safety of the community over any other factor.
“It will need to take into account the local rate of vaccination, both in adults and children, and the capacity of the Australian health system to keep up with ongoing growth in demand for services, particularly in our public hospitals, while also ensuring that there is sufficient surge capacity available to deal with future community outbreaks,” he said.
“It will also need to consider the adequacy of quarantine facilities, and the continued effectiveness of the vaccines deployed in Australia in preventing hospitalisation and serious illness, including in relation to variants.”
Khorshid said a key component of the strategy would be mandatory Covid-19 vaccinations for outbound and inbound travellers, with only limited exemptions for defined medical reasons. Dedicated quarantine facilities for those travelling to and from countries deemed as being higher risk would need to be used, along with rapid screening tests at Australian airports and ports.
He proposed the adoption of a traffic light or similar classification system that sets transparent criteria for the easing of borders with individual countries or regions, taking into consideration the prevalence of Covid-19 – including variants, vaccination rates and the degree of confidence in local testing regimes – as well as containment strategies and data transparency.
Risk mitigation measures should be attached to the traffic light system, including border closures with very high-risk countries and regions, requirements for onshore and offshore testing, and mandatory time in home or designated quarantine, he said.
Currently, vaccination levels in Australia are too low to consider opening the borders, but this could not continue indefinitely, Khorshid said, proposing a public campaign and discussion around reopening to reduce people’s fear, and further promotion of vaccination.
“In terms of timing, if a high proportion of the population are vaccinated by the end of the year and our health system is prepared, then we could see border closures progressively eased from early in the new year, initially targeting travel with low-risk destinations,” Khorshid said.
Prof Catherine Bennett, the chair in epidemiology at Deakin University’s school of health and social development, agreed a strategy could be developed now.
She said the country could reopen in stages as soon as the second half of 2021, initially focusing on broadening the reasons for people to enter Australia, allowing workers and students in, and opening up further travel bubbles with countries with similar Covid control measures and vaccine uptake.
There could also be a wider range of justifications for leaving Australia and once the waiting list of queued returnees is finally completed, Australians must be able to leave knowing they can return, she said.
“But the frustrations and increased cost of managing travel bubbles will wear thin quickly,” she said, meaning that the government should announce, by the end of the year, that international borders will open to vaccinated tourists by March 2021.
“This will spur the last of those still hesitant to get vaccinated whether they want to travel themselves, or want the protection it affords knowing the virus will soon be back in the community,” she said.
Vaccinated travellers should not have to quarantine, but there should still be testing in high-risk workplaces or for people who present with serious Covid-like symptoms to track the variants circulating and to identify if there are clusters that might need managing by tracing and isolating, she said.
“Vaccination status will become increasingly important and uptake should be approaching 70% by the end of 2021 and will lift again in 2022 as it becomes clearer that vaccinated people are the ones at the front of the queues when we trial new international travel corridors or reduced quarantine requirements,” Bennett said.
“We will continue to have the occasional cases appear in the community and vaccination will not only protect people from infection, but also protect them from some public health orders because of their reduced infection and transmission risk.”
She agreed with Khorshid that expanding purpose-built quarantine facilities was essential and said this should be complete by the end of the year.
“As the number who cross the border increases, we will start to triage people according to risk of infection and of transmission to others,” she said.
“Vaccinated returnees will be able to test and quarantine at home for five to 10 days if they return two negative test results. Hotel quarantine will serve non-vaccinated travellers from countries outside travel bubbles. Cabin-style quarantine will used for those from high-risk countries with high infection rates or a high prevalence of variants of concern. Anyone who tests positive for a variant of concern in Australia will also isolate in these top-tier quarantine centres.”
Prof Stephen Duckett, a health economist and director of the Grattan Institute’s health program, said the Victorian government had managed to produce a detailed roadmap for reopening the state after experiencing a second wave of Covid-19 that saw the state in a prolonged lockdown. They had done so by engaging leading epidemiologists, infectious diseases experts and researchers, and the federal government needed to do the same to develop a roadmap towards reopening the borders, he said.
“Of course the first thing they would need to do as part of the roadmap is get the vaccination program fixed,” Duckett said. “I think one of the reasons people aren’t rushing out to get vaccinated is because they see the government making mistake after mistake with it. The government needs to run community-specific campaigns tackling vaccine hesitancy, but they can only run those campaigns if they know people listening to them can get a booking when they try to make one.”
He said while the federal budget presumed a mid-2022 gradual reopening, “the prime minister seems to be backpedalling on that”.
“I think the real date is some time after the election because I don’t think the prime minister wants to open before then,” he said.