The politics of vaccinations

26 August 2021
Tom Bramble

The Berejiklian government in New South Wales, despite the condolences it offers at every press conference to the families of those who have died from COVID-19, continues with its bankrupt strategy. Everything the government has done since the outbreak began suggests that it will ease public health restrictions once the vaccination targets are met, even if new daily cases are running into the thousands. This is why the government refuses to specify a target for case numbers and why it is now trying to shift attention away from daily new cases to hospitalisation rates.

But the idea that millions of people can be safely exposed to the Delta strain and the mutations that follow it simply because vaccination coverage has reached 70 or 80 percent is extremely dangerous. Several million people in New South Wales will be directly subjected to COVID if the government’s plan goes ahead.

The first group is the state’s 2 million children and teenagers, only tiny numbers of whom will have been vaccinated by the time the government intends to lift restrictions. Even with restrictions in place, young people are disproportionately being infected with the Delta strain. Thirty percent of cases in the state are aged under 19. In the ACT, 43 percent of active cases are aged 17 and younger, while in Victoria 47 percent of active cases are under 20, and nearly one quarter of the total are younger than 10.

In the United States, where vaccination rates for adults are much higher than in Australia, new paediatric hospital admissions have risen to a high of 400 a day, easily surpassing the previous record of 250 a day in the worst of the northern winter outbreak. This is in August, traditionally the lowest season for paediatric admissions in the US.

There is much talk that children and teenagers suffer milder symptoms than adults. But this ignores the fact that many of those who recover will suffer horrible and potentially long-lasting health problems—so-called long COVID.

Yet the Berejiklian government is talking about relaxing restrictions and opening schools sometime in September.

Indigenous people are also in the firing line. Unless the vaccination rate rises substantially, it could well be that only 40 or 50 percent of Indigenous people are vaccinated when the 80 percent overall target is reached.

Then there are the working-class populations in the most severely affected areas in western and south-western Sydney. Even though NSW Health is prioritising these regions, vaccination rates still lag well behind the rates in the eastern suburbs and north of the Harbour. Again, if restrictions are reduced, these areas could be exposed to much higher rates of infection. In addition, workers from these areas could more easily transmit the virus to other parts of the city, sparking off a fresh wave of infections.

The Berejiklian government’s approach to vaccination is informed by the individualistic mindset that rules conservative thinking. Vaccines may give individuals some basic protection, but only when vaccination rates are significantly higher than the government’s current targets will vaccinations serve their purpose—that is, to provide herd immunity.

We do not yet know what rate of vaccination will be needed. The rate for polio is 60-65 percent but for measles it is 95 percent. Given transmissibility of the Delta strain, herd immunity at anything less than 90 percent coverage, including for every vulnerable group, seems unlikely. That is the very least that needs to happen, but it is also far more than what the government intends to provide.

We only have to look at countries with high vaccination rates to see the consequences of prematurely easing restrictions. England is the best example, with 75 percent of the population 16 and over fully vaccinated. On 19 July, the Conservative government removed all restrictions on mask wearing, gatherings and travel. After new daily infections initially dropped from 50,000 to 25,000, they bounced back in August and are now running at more than 30,000 a day— substantially higher than the average recorded in 2020, when no-one had been vaccinated. Even though vaccinations have kept the mortality rate down, England is still recording 100 or more daily deaths (more than 36,000 per year). The figures would be higher still if the public had not continued to maintain some basic health practices in defiance of the government’s reckless approach.

In Israel, 78 percent of the population 12 years and over has been vaccinated, but the country is reporting 7,500 new cases daily, double the level in the first half of August and one of the highest rates of infection in the world. Those vaccinated are much less likely to suffer hospitalisation and deaths, but still bear the scars of COVID.

An Oxford University study published in the Lancet in April confirmed that many of those who have survived COVID have developed anxiety, depression and insomnia, along with significantly higher risk of dementia in the months after infection. In a Lancet article in July, researchers from Imperial College London reported that people who had recovered from COVID exhibited significant cognitive deficits as a result of their infection. Those who had been hospitalised and ventilated suffered a reduction in cognitive functioning equivalent to a seven-point drop in IQ.

The experience of Israel, one of the first countries to achieve mass vaccination, and now the US, also suggests that the efficacy of the vaccines declines over time and that booster shots are needed to maintain some immunity. But if wealthy countries continually administer booster shots, this draws supplies away from poorer countries where only tiny numbers of the population have received even the first shot. COVID will never be eliminated if whole areas of the planet do not have even the most basic protection.

Once we understand the political purposes to which the vaccination program is being put—namely, to speed up business reopening rather than to get as many people vaccinated as humanly possible—we can assess realistically why a growing number of employers are demanding that staff be vaccinated.

It is not that the likes of Qantas CEO Alan Joyce, who has sacked thousands of staff since the start of the pandemic, have suddenly been moved by concern for the health of their workforces. Management at Qantas is insisting that staff get vaccinated because the company wants to get back to “business as usual” with the fewest possible restrictions. The company wants international travel—the last thing that can safely return to normal given the global pandemic and the appalling state of Australia’s quarantine facilities—to resume so that the business can prosper.

The same is true with the bosses at fruit canning company SPC, which requires staff to be vaccinated by November. Vaccinations are a cheap, quick-fix way of addressing the health risks of the pandemic and, as we have seen, are no guarantee that the company’s workers will be kept safe in its factories. Vaccinations do not deal with the issues of ventilation, safe physical distancing and wearing respirators or masks, which are crucial to reducing the risk of infection, but which will cost the bosses money.

Then there is the call for vaccination passports by the hospitality industry, which is desperate to reopen cafes, restaurants, pubs and hotels. This is simply a way of reopening for predominately affluent individuals, currently the most vaccinated group, and damn the consequences for their staff forced to wait tables and serve drinks in crowded, frequently unventilated venues. There is no reason such venues should be operating in the current health crisis; staff should be provided financial support while the venues remain shut.

Understanding why some bosses are demanding that staff get vaccinated as a condition of employment tells us why they are the last people who should be making such decisions. Governments, working on the basis of published health advice, should make public health orders to this effect where justifiable.

Our opposition to employers forcing their workers to be vaccinated is not driven by opposition to vaccines as such; vaccinations play an important part in a mix of measures to protect the community against infection. If employers wish to vaccinate their workforces at their own expense, that is a different matter, but vaccination should not be a condition of employment in most industries.

There are industries such as health care and aged care which are truly essential and where the nature of the work brings staff into close contact with vulnerable people. Here there is a case for mandating that staff be vaccinated to minimise risk to patients or clients. This is not unprecedented: health care workers in hospitals, for example, must currently have flu vaccinations annually and those working in theatre must have other vaccinations besides. Other categories include staff working in hotel quarantine or border control where they are required to interact with people at increased risk of being infected with COVID.

But vaccinations cannot be made a condition of employment in these sectors until all staff have been afforded the opportunity to have them. The Morrison government’s shambolic vaccine rollout meant that its initial plan to vaccinate all aged care workers by early April was rendered impossible. At the end of June, it mandated that all workers in the aged care sector must have received their first vaccination by mid-September as a condition of continued employment. This is simply a way of diverting attention away from the federal government’s stuff-ups, which have put the vaccination program months behind, and places responsibility on the shoulders of individual workers. It also contributes to the idea that low vaccination rates are the result of ignorance or conspiratorial opposition to vaccines by individuals, not structural issues of supply.

Vaccines are an important part of protecting the population from COVID. But current vaccines are not a silver bullet—especially with the Delta strain, which can still be caught and transmitted by vaccinated people, and especially when the evidence from overseas suggests that Australia’s targets are too low to prevent mass infections. Likewise, while vaccines can justifiably be mandated for workers in some industries, they are not justifiable for all workers, especially when doing so is used as an excuse not to take other measures to make workplaces safe.

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