What went right (and wrong) with Australia’s COVID-19 response?

Australia coped better than many countries during COVID-19, avoiding severe health system collapse, mass casualties, and deeper economic downturns. 

But the government’s COVID-19 Response Inquiry Report found significant collateral damage that could have been avoided – and that pharmacists were not activated in the vaccine roll-out soon enough.

Pharmacists should have been involved in the vaccine rollout much sooner

A delayed vaccine rollout was costly for Australia – leaving people vulnerable to severe illness and death, with a $31 billion economic loss also incurred – as we transitioned to ‘living with COVID-19’.

The Inquiry found that the COVID-19 vaccine rollout was way too slow to activate pharmacists and other vaccinators. 

While the vaccine rollout commenced in Australia in February 2021, community pharmacists were not included until August that year. This contrasts with international responses, including the United States – where pharmacists began vaccinating patients in December 2020.

But pharmacists are clearly a vaccinator of choice, delivering around 40% of weekly vaccinations since the start of the rollout.

Vaccination scope harmonisation needs to happen, NOW

The scope of practice changes that occurred during the pandemic revealed inconsistencies in vaccination legislation across Australia. While pharmacists can administer COVID-19 vaccines throughout Australia, legislation around other vaccines, such as herpes zoster (Shingrix), differs per state and territory.

The inquiry panel agreed that a nationally consistent approach is required, and Scope of Practice Review recommendations harmonising existing legislation around what services pharmacists provide should be prioritised.

Prescribing restrictions on ivermectin: wrong approach

Unapproved COVID-19 treatments such as ivermectin and hydroxychloroquine were in high demand during the height of the pandemic, with pharmacists concerned this would lead to supply shortages for those prescribed the medicines for approved indications.

But the government’s approach of implementing prescribing restrictions fueled mistrust, particularly given ivermectin is a safe drug when used correctly.

Instead of restricting off-label use of the drug for COVID-19, which had no proven clinical benefit, alternative measures to better manage demand should have been used to safeguard supply for the small number of Australians prescribed the medicine for legitimate users.

Equity fail: Antivirals mainly went to the wealthy

Access to COVID-19 antivirals is not equitable, even for those more at risk of severe complications. First Nations people, who have nearly 70% higher risk of dying from COVID-19 are 25% less likely to receive antivirals. Australians based in rural areas are also 37% less likely to obtain these treatments compared to those in cities.  

There’s even a pronounced disparity in cities, with individuals over 70 in Sydney’s affluent Eastern suburbs almost twice as likely to access antivirals compared to those in the Western suburbs.

Better measures to provide access to people in priority populations are required.

Vaccination rates need an urgent boost

The lack of real time evidence based policy and the lack of transparency has driven a large decline in trust, said Minister for Health and Aged Care Mark Butler in a press conference held on Tuesday (30 October).

‘The erosion of trust is not only constraining our ability to respond to a pandemic when it next occurs, but we know it’s already bled into the performance of our vaccination programs, including our childhood vaccination program.’

But according to social scientist and public health expert Professor Julie Leask: ‘It’s a slight decline in public trust. It’s not collapsing. It hasn’t taken a nosedive. There is an issue, but the sky is not falling. To claim it is worse risks people responding to that perception negatively.’

But to rebuild what is lost, a key action is the development of a national strategy to instil community confidence in vaccines and improve vaccination rates by target dates is an urgent priority, particularly among priority cohorts.

There should be an emphasis on lifting early childhood vaccination rates for other communicable diseases to pre-pandemic levels.

Australians won’t accept the same restrictions next time

When the next pandemic inevitably hits, the inquiry found that Australians are unlikely to accept the same measures. So a different pandemic response will be required, based on the Australia we are today – not the pre-pandemic version.

‘Right now, we are arguably worse placed as a country to deal with a pandemic than we were in early 2020 for a range of reasons,’ said Minister Butler.

This includes a fractured and fragmented healthcare system and an exhausted healthcare workforce.

[So we need] to build … a high-level playbook for the next pandemic because we know there will be a next pandemic.’ 

One example of this is vaccine mandates. The report found the application of vaccine mandates to the general population during COVID-19 reduced public trust. Any future implementation of vaccine mandates must be carefully considered, weighing their potential to undermine public trust and increase hesitancy against the need to protect public health. And thresholds to remove those mandates must be defined when they are instituted.

The new CDC could re-engage Australians with vaccination, but pharmacists need to be engaged

Yesterday the Australian Government immediately implemented the recommendation to establish an Australian Centre for Disease Control (CDC) committing $217.5 million to shift from an interim to ongoing arrangements. The intent is for a more coordinated, transparent approach to decision making for both pandemics and chronic health conditions.

The independent CDC is expected to launch on 1 January 2026, pending passage of legislation through federal parliament.

Welcoming the Federal Government’s commitment to establish a CDC as part of our national response to preventable disease, PSA National President Associate Professor Fei Sim FPS said, pharmacists can and should be better utilised as trusted healthcare professionals.

‘We have long known that the skills and expertise of Australia’s pharmacists are not fully utilised in reducing the burden of preventable diseases,’ she said. 

‘While pharmacists are delivering more vaccinations than ever before, there is still a long way to go to make vaccination standards consistent across the country, recognising that a pharmacist immuniser in one state is just as qualified as a pharmacist immuniser in another state, and should be able to provide the same vaccinations to the same subsect of patients.’

PSA continues to fight for all pharmacists across the country to be able to deliver all vaccines to patients of all ages, under a nationally consistent vaccination schedule.