VC op-ed: Vaccination the only way for Australia to emerge from its gilded cage
The last few weeks have proven that vaccination is the only sustainable, long-term strategy for Australia to emerge from its ‘gilded cage’.
There is no viable long-term strategy that says we can simply keep the virus out. COVID-19 will become a globally endemic virus if it is not already, and just as is the case for the Spanish Flu, its genetic progeny will almost certainly be with us for the next 100 years or more.
While most of the vaccination debate in Australia has focused on individual risk, we must acknowledge that vaccination is both a tool to protect one person and a public health intervention to protect communities.
Balancing individual risk and the wider community benefit, including at Deakin, must be considered.
There is no doubt that getting vaccinated is part of the social contract that enables us to lead full and healthy lives – it is a responsibility that sits alongside our rights.
In this context, I would argue that as a University community, we have a duty to lead by example. After all, the combination of clean drinking water and vaccination has had the greatest impact of any interventions on human health.
The limited supply of vaccines undoubtedly prolongs our path to a world where we manage COVID-19 as an endemic virus. Given this, it is important to look at all options, including returning, at least until we achieve high vaccine penetration, to far greater use of the AstraZeneca (AZ) vaccine.
The AZ vaccine is highly effective. United Kingdom data would suggest two doses prevents 80-99 per cent of hospitalisations and 75-99 per cent of deaths.
While vaccination seems to be about 10 per cent less effective against the Delta variant in preventing symptomatic disease, it appears to be as effective in preventing hospitalisation when compared to the Alpha variant.
The latest UK data suggest that 96 per cent of Delta-related hospitalisations are prevented.
So, we could expect to see at least 80 per cent, and perhaps as many as 95 per cent, of hospitalisations and deaths avoided in a fully vaccinated population. I suspect that in March 2020, the AZ numbers would have been regarded as unbelievably good.
Given this, what would be the net impact of the greater use of AZ in managing the pandemic in Australia?
To date, Australia has had some 34,500 cases of C19 reported with 924 deaths, a mortality rate of 2.7 per cent. However, given that there are undoubtedly undiagnosed mild cases and that management has improved throughout the pandemic, it seems not unreasonable to suggest a mortality rate of at least 1 per cent (in an unvaccinated population) in considering the risk-benefit profile of vaccination.
The adult population of Australia is around 20 million. The risk of death with the AZ vaccine is reported as being 1 per million. So even if we vaccinated the entire adult population with AZ we would expect to see 20 deaths from side effects.
The following table is a very high-level assessment of what the risk-benefit profile would look like with increasing numbers of COVID-19 infections in our population. It is based on vaccinating the entire adult population with AZ – not because this is realistic but to consider the risks and benefits.
The final row is what would happen with 10 per cent of the population being infected – not dissimilar to the UK and the US to date.
Deaths from Vaccine
Deaths with no vaccine
Deaths from C19 (80 per cent vaccine effectiveness)
Deaths from C19 (90 per cent vaccine effectiveness)
Deaths from C19 (95per cent vaccine effectiveness)
Lives Saved in a vaccinated population
(10 per cent of the population)
19,980 – 23,530
There is no doubt that an analysis that is far more complex than this, including stratification by age and comorbidity, Alpha vs. Delta variants etc., should be used in finalising the approach. However, while this would nuance the numbers, it is unlikely the macro conclusions would change.
The key issue is that the risk of severe morbidity from vaccination is spread unequally across the population. The question then is, is society prepared to consider the overall health of the population and accept that this will mean small numbers of people place themselves at marginally greater risk for a far greater benefit to the whole community?
After all, we already ask this of many people in our community; emergency services, health staff, defence force personnel, SES volunteers – the list is long.
There will be those who say we must consider factors such as years of life saved – and this is an area where there is no consensus. There seems to be little clinical, public or political appetite to consider the death of an 80-year-old as different from someone less than 40.
In no way can we understate the implications of just one death, but as a community, we must take a genuinely public health approach because widespread vaccination with AZ will save lives in any situation where there is a cumulative risk of more than 10,000 infections in an unvaccinated population.
Australia cannot rely on keeping COVID-19 out of the country, as the last few weeks have shown. Vaccination is the only way out of the dilemma we face. We cannot afford to delay, and it seems self-evident that we need to reconsider the use of AZ in younger patients.
As has been acknowledged for nearly 70 years, health is “the state of complete physical, mental and social well-being” and far more than simply the absence of disease.
While I have not touched on the health impacts of ongoing lockdowns, this should further push us towards the most rapid path to complete vaccination we can achieve.
So, given all of this, what should the position of Deakin University be towards mandatory vaccination to be a part of our community? I am unequivocally of the view that we have a duty to be vaccinated unless there is an overwhelming health reason why an individual cannot take any of the available vaccines.
Across multiple times in my life, I have had to be vaccinated to pursue study, career or social opportunities (Yellow Fever for travel, for example). I knew in being vaccinated, I was not simply protecting myself.
For COVID-19, the data leaves no room whatsoever for the balance of risk – a vaccinated community is far safer than an unvaccinated community.
If there is an intervention available that prevents more than 95 per cent of hospitalisations and reduces by more than 80 per cent my chance of passing a potentially fatal disease on to others, not taking this up is at best ill-advised and potentially verging on the negligent.
Once the entire adult population have access to vaccination, which will be later this year, I believe that as a community, we need to consider very carefully whether we mandate vaccination to continue to be part of our university community.
We are not alone in considering this, and many United States universities, both public and private, have mandated vaccination as a condition to return to campus in their autumn.
We are fortunate to be living in the country with all of the opportunities and rights this brings – but with rights always comes responsibilities and there is no doubt getting vaccinated is a responsibility we all have.
Professor Iain Martin is Vice-Chancellor of Deakin University and former Head of Surgery, Dean of the Faculty of Medical and Health Sciences at the University of Auckland.