Exclusive: 26.8 million doses of Covid-19 vaccine wasted
New details of the Covid-19 response – hidden by the government under ‘commercial-in-confidence’ – reveal no one is properly in charge and that huge quantities of vaccine have been wasted.
More than 26 million doses of Covid-19 vaccines have been wasted in Australia since they became available two years ago, according to the hidden findings of a report commissioned by Health Minister Mark Butler last year.
The report also warned that Australia could face a “catastrophic” new Covid-19 variant, which may render vaccines ineffective; that contradictory health advice to government is undermining confidence in vaccines; and that advisory structures need an overhaul to be ready for another emergency.
The report, written by former senior bureaucrat Jane Halton, warned that, even after the change of government, nobody is properly in charge of the Covid-19 response. “There is no clear mechanism nor mandate across these structures to ensure all sources of input are integrated as a basis for decisionmaking, distribution, education and delivery.”
It said the structures and processes that existed before the pandemic “were not fit for purpose” and did not work in an emergency context. “With the likelihood of continuing waves of Covid-19 and the need for ongoing, integrated advice, new advisory structures and mandates will be required,” the report said. “It is timely to consider the role and nature of existing structures and processes. The ad hoc arrangements put in place at the beginning of the pandemic require updating.”
These further details emerged as Butler confirmed that between three and four million Australians have contracted Covid-19 in the current infection wave, which began in October last year, and that 2600 have died, of whom 800 were in aged care.
Butler said the wave is now subsiding and case numbers are down 80 per cent on the December peak, which was lower than for previous waves. He defended national cabinet’s decision to wind back mask-wearing and other protections late last year.
In September, Butler released the summary and recommendations of the
Halton report, which he commissioned in June. It covered the purchase of Covid-19 vaccines and treatments under the previous
“What the pandemic has taught us is the need to have systems and processes in place so we can respond very quickly. That means working with drug developers, drug manufacturers and suppliers, and supply chains, to ensure that Australia is a preferred partner and customer.”
government and what would be required in the future. At the time he did not release its full details, saying they were “commercial-inconfidence”.
The Saturday Paper applied for the full report under freedom of information (FOI) law and published details last month of what was obtained. Sections of the 153page document were heavily redacted and some pages were missing, omitted without acknowledgment.
Among the grounds cited by the Health Department to support its redactions was that the relevant sections might disclose cabinet deliberations. The Saturday Paper requested a review of the FOI decision and was provided with a less-redacted version this week, which includes significant further details.
While the reviewer upheld several of the department’s arguments and maintained some redactions, its claim about cabinet deliberations was rejected and many of the blacked-out sections were restored. All of the missing pages were either fully restored or fully redacted, but with their existence at least noted.
When he released a summary of the report, Butler said the review was to examine whether the arrangements the former government made would continue to be “fit for purpose”. He indicated those arrangements would continue through 2023 and that the new government would ensure advice structures were made more flexible.
The fuller version of the report shows Halton warned against thinking the Covid-19 crisis was over and urged the government not to repeat its predecessor’s mistakes by failing to anticipate the possible arrival of new variants.
She said the government should order upgraded vaccines accordingly and expand eligibility for vaccines and treatments. At the time, a spokesperson for Butler indicated he expected to receive advice from the group of external medical experts known as the Australian Technical Advisory Group on Immunisation (ATAGI), relating to accessing fifth Covid-19 vaccinations soon.
The less redacted version of Halton’s report was provided to The Saturday Paper on Tuesday evening this week. On Wednesday morning, Butler announced that Australians were now eligible for a fifth shot, provided they had not had either a Covid vaccine or the virus itself in the previous six months. Those doses will be available from February 20.
Butler also revealed that 10 million doses of a new Omicron-variant-specific
Pfizer vaccine had been purchased and would be available in Australia from March.
The minister suggested the duration of the current wave had surprised the government.
“There’s no doubt that this wave has endured for longer than was expected at its beginning, longer than the advice that was received by governments, particularly based on more recent waves, than had happened in parts of South-east Asia,” he said. “It was not short or sharp, it lingered for longer. And it had a very significant impact on the community, our health system, and many individuals, tragically resulting in the loss of many lives.”
Butler said it was important to understand how profoundly the pandemic has impacted the community.
“And it is my intention to make sure that we learn the lessons of the past few months, and constantly make sure that the response that all governments, including the Commonwealth, put in place to deal with what inevitably will be the next wave of Covid some time over the course of 2023 is aligned with the best understanding and the best evidence,” he said, adding that the chief medical officer, Paul Kelly, would provide him with advice on lessons learnt.
Kelly said ATAGI had changed its advice from recommending a gap of three months between infection or vaccination and a booster shot, to six months, which he said was mostly about “simplicity of message”.
He urged people to get booster shots to protect themselves and the wider community.
“Vaccine does help,” Kelly said. “It does work. It does protect people, particularly those in that severe, severe end of vulnerability.”
In her report – completed a month before the latest surge began – Jane Halton warned that the situation could worsen again significantly.
“A catastrophic variant which renders some or all existing vaccines completely or partially ineffective cannot be ruled out,” she wrote. “The trajectory of the pandemic for at least the next 12 months is uncertain.”
This week, Halton, now global head of the Coalition for Epidemic Preparedness Innovations, expanded on her findings.
“We hope that there will not be a catastrophic variant and we’re not necessarily expecting one,” she told The Saturday Paper. “But what the pandemic has taught us is the need to have systems and processes in place so we can respond very quickly. That means working with drug developers, drug manufacturers and suppliers, and supply chains, to ensure that Australia is a preferred partner and customer, so that Australians get timely access.”
She declined to comment on the government’s decision to withhold so much of her report initially.
Halton’s previously hidden findings included that 26.84 million doses of vaccines have been wasted in Australia – 8.33 million doses of adult Pfizer shots, 6.8 million Astrazeneca, 5.08 million Novavax,
5.04 million of Moderna for those aged over six years, and 1.59 million of Pfizer for children aged five to 11. That equates to a current wastage rate of 16.8 per cent.
Butler’s spokesperson told The Saturday Paper that, as of this week, the wastage rate has risen to 18.2 per cent, which the government says is within the World Health Organization’s acceptable levels. Halton’s report noted that Australia has donated other excess stock, where possible, to regional neighbours. The government says it has also donated 52.1 million doses to Indo-pacific countries plus another 16.8 million doses through the COVAX facility that supports immunisation in the developing world.
Asked if the wastage rate could have been reduced had things been done differently, Halton focused on the future.
“There are opportunities going forward to streamline procurement and delivery which would make a difference to wastage,” she said.
The report found that as demand for third and fourth shots fell – only one in three people aged 50-64 have had a fourth dose – the emphasis had shifted from administering every available vaccine to ensuring that every opportunity to vaccinate someone was taken.
That meant opening multidose vials to vaccinate single individuals who asked to be immunised, rather than waiting until there were enough to use the lot. This led to inevitable wastage.
Halton found that various advisory bodies’ overlapping roles and sometimes contradictory recommendations had created confusion and served as a barrier to Australians accessing the vaccines and treatments they needed.
She suggested that such barriers, including poor communication with the public and the medical profession, needed to be addressed to encourage a renewed uptake of vaccines. Butler this week said that a new communication campaign would begin in the first half of the year.
Halton warned of “the relative likelihood and severity of possible scenarios” involving new variants and said that, given the time line for securing more vaccines, “it is prudent to prepare for medium severity demand in 2023”.
She wrote, “The Commonwealth should ensure it maintains the capacity to scale-up to meet the demand expected of an emergency scenario to limit deaths and hospitalisations in the event of a severe new variant.”
Halton queried the influence of ATAGI more than once in the sections of her report that were previously redacted, suggesting its focus had been too linear and its advice accepted too uncritically. She said this allowed the advice to be perceived as government decisions.
“Understanding about eligibility, safety, and access has been hampered by an absence of clear communication,” she wrote. “Constant changes to ‘the rules’ have been difficult to understand and was reported as a barrier to access by consumers. Clinicians have reported confusion and patient difficulty in exercising choice. For example, the ATAGI ‘guidance’ has led to restricted access to Novavax as a booster, resulting in several patients reporting to the review that they have been refused access to this vaccine as a booster as ‘you don’t qualify’.”
The report said communication to both patients and doctors about “actual eligibility” should be “both clear and permissive”.
“At times, the ATAGI guidance and published statements have served as a gatekeeper to the use and uptake of vaccines, with advice treated as de facto decisions about eligibility,” she wrote.
“In the medium-term, it will be important to ensure that advice to assist decision-makers is integrated, does not overlap or duplicate existing statutory roles, and understands the roles of decisionmakers.”
The decision-maker was the executive government. The integration role “should be undertaken by the Department”.
In comments to The Saturday Paper, Halton said: “With all this experience, making sure that your advisory structures and bodies are fit for purpose, able to allow rapid and well-founded advice to help ministers – who are ultimately the decision-makers – make the best decisions in the interest of the Australian population is fundamental to our health security.”
The government has indicated it will respond formally to Halton’s report imminently but had not done so at time of press.
The minister’s spokesperson declined to provide direct answers to questions about whether the government had made changes in response to Halton’s findings and instead repeated what they had said earlier in the week.•