It's been a big week on the COVID vaccine front in Australia, with the first doses of the Pfizer-BioNTech vaccine touching down in Sydney on Monday and the Therapeutic Goods Administration approving the Oxford University-AstraZeneca vaccine on Tuesday.
Australians will begin receiving Pfizer jabs from next week, with the government set to distribute the first 80,000 doses to states and territories, as well as among aged and disability care residents and staff nationally.
Australia is kicking off its vaccination program many weeks behind some other countries. While this has attracted some criticism, it also presents an opportunity to learn about what's worked — and what hasn't — abroad.
In short: it seems that vaccination rollouts are easier in countries with smaller populations (like Israel), strong universal healthcare systems (like the UK), and the ability to produce doses locally.
Here are some lessons from the countries ahead of us with their vaccine rollouts.
Israel
Israel is leading the world by a mile in vaccinating its population, with almost half of its 9 million citizens having received at least one vaccine dose.
The country's highly coordinated universal healthcare system — along with help from its army reserve medics — has seen the vaccine rolled out with military precision.
Swapping data for vaccines
Israel in January signed a unique agreement with Pfizer essentially exchanging real-world data on how the vaccine performs across different demographics for a steady, early supply of the extremely effective vaccine.
The country's small population and robust digitised health system meant it was well-placed to supply that information.
The early data has reassured policymakers around the world, showing that the vaccine performs as well, if not better, in the real world than in clinical trials.
Even the first of two vaccine doses "is effective and reduces morbidity and lowers hospitalisations by many tens of per cent", said one of the country's four "health maintenance organisations", Maccabi.
On Sunday, Israel's largest healthcare provider, Clalit, revealed a 94 per cent drop in symptomatic COVID-19 infections among vaccinated citizens in a large study of 600,000 Israelis.
Countering hesitancy and resistance
Despite the broad success of the program, Israel has encountered resistance from some groups, including ultra-orthodox Jewish and Arab citizens. Both communities have been hit hard by the virus, which is running rife in Israel.
In response, Israel plans to limit attendance at cultural or religious gatherings to people who have been fully vaccinated, have recovered from COVID-19 or can show a recent negative test result. This "green pass" system will also be used in other settings, granting greater freedom of movement to those who are vaccinated.
How and whether Israel can win over its faith communities could hold critical lessons for Australia. Here, coronavirus misinformation has spread in some religious communities at various points in the pandemic. There has also been some Christian opposition to the use of foetal cells in the development of the Oxford AstraZeneca vaccine, which most Australians are expected to receive.
But wait…
After Israel was criticised for failing to secure vaccine doses for some 4 million Palestinians living in the West Bank and Gaza Strip, it agreed to transfer 5,000 doses to Palestinian health care workers, but this won't go far. Whether and when these Palestinians are immunised remains to be seen.
United Arab Emirates
Shortly behind Israel in vaccinations per capita is the United Arab Emirates.
Like Israel, the UAE has a centralised universal health care system which has prioritised securing and distributing vaccines.
The country has also worked hard to boost public confidence, with prominent Islamic figures getting their shots in front of news cameras, while the nation's Fatwa Council ruled in favour of COVID vaccines.
Going hard and early
The Gulf state went hard and early with its vaccination strategy, inoculating frontline medical workers and government officials from September with Chinese vaccines that were still in phase three clinical trials.
The country has close ties to China, which has proved critical to the rapid rollout. It approved the Sinopharm vaccine faster than China itself, which is what most UAE citizens have received so far.
While the Gulf state claims this vaccine is 86 per cent effective, Sinopharm has separately reported an efficacy rate of 79 per cent.
Looking beyond its borders
The UAE is now buying doses on behalf of other nations, including Egypt, which became the first African country to begin vaccination.
It has established a production facility in Abu Dhabi to produce the Sinopharm vaccine, making it the first country in the Middle East to produce COVID-19 vaccines.
The United Kingdom
While the UK bungled some aspects of its pandemic response — it was criticised for being slow to impose lockdown restrictions and secure enough PPE, among other missteps — it's done well on the vaccine front, having administered more than 15 million first doses by February 13.
Gambling on a vaccine
Prime Minister Boris Johnson took an early gamble — spending big on vaccine development and agreements — and the investment appears to be paying off.
Aside from striking a deal with Pfizer some three months before the EU, Britain has had clear access to the Oxford AstraZeneca vaccine, highlighting the benefit of producing vaccines in your own backyard.
Scott Morrison has since followed suit, with our own vaccine giant CSL set to produce more than 50 million doses of the AstraZeneca vaccine.
Mass vaccination sites and familiar clinics
The UK's largely successful vaccine rollout has owed much to the effectiveness of and public trust in its National Health System.
The threat of the highly infectious "UK strain" meant it was vital that mass vaccination sites had good ventilation, lots of space, and ideally plenty of parking.
Britons can grab a jab in sports stadiums, churches, mosques, nightclubs and even an open-air museum famous as the set for Peaky Blinders. At the Salisbury Cathedral, you'll even be treated to the church organ — it's a "buoyant and joyful" atmosphere, according to the Very Reverend Nicholas Papadopolous.
Boris Johnson has said mass vaccination clinics will run 24/7 as soon as more doses are available.
UNSW modelling has suggested mass vaccination sites will be critical for Australia to hit its target of vaccinating all Australians who want a dose by October. Like the UK, we will need to combine these mass sites with GPs and community pharmacies.
Unlike in the US — where people have had to navigate unfamiliar and finicky online portals to book their vaccinations, or overwhelmed telephone hotlines — the UK has put GPs and hospitals in charge of scheduling. That has allowed doctors to triage their own patients according to who's most vulnerable, while patients can book through familiar channels.
Loading...The USA
The early days of the US vaccine rollout were described by incoming President Joe Biden as a "dismal failure", but the pace has since ramped up, with around 1.5 million Americans being vaccinated each day.
A lack of federal coordination and funding is one of the reasons under-resourced state health departments have struggled to get the shot into people's arms.
Supply shortages have also hindered the rollout, leading to a shambolic scheduling system in which people's appointments have been cancelled without warning days before.
Despite the challenges, the US has rolled out more shots per capita than most other countries, following an aggressive development and procurement strategy.
Backing the right horses
The Trump administration invested heavily in the development of US firm Moderna's mRNA vaccine. This was seen as a gamble, as Moderna was a small player in the vaccine landscape and no mRNA vaccine had previously been approved for human use.
But the Moderna vaccine proved to be both safe and extremely effective, with an efficacy rate of around 94 per cent in clinical trials.
The US has also secured large supplies of the Pfizer-BioNTech vaccine, which boasts an even higher efficacy rate of around 95 per cent in clinical trials.
While both vaccines are in high demand, President Biden just secured an additional 200 million doses.
In selecting these mrNA vaccines, the US has offered its citizens the best possible protection, meaning herd immunity could be achieved faster.
Loading...Meanwhile, in Australia
By contrast, most Australians will receive the Oxford AstraZeneca vaccine, which has a lower efficacy rate in clinical trials. It also appears to be ineffective against the South African variant, unlike the Pfizer shot.
The lower efficacy rate of the AstraZeneca vaccine means a higher proportion of our population will need to agree to be vaccinated to achieve herd immunity, according to University of Western Australia epidemiologist Zoe Hyde.
Part of the reason Australia has prioritised this seemingly less effective vaccine (about 82.4 per cent efficacy) is because it doesn't need to be stored at ultracold temperatures like the mRNA vaccines, which pose serious distribution challenges.
It's also simpler for us to produce the Oxford AstraZeneca vaccine onshore than an mRNA vaccine, giving us a more secure supply.
However, Dr Hyde questions why we are not predominantly using the Novavax vaccine, which has a higher efficacy rate (around 89.3 per cent in phase three trials) but can be stored at regular fridge temperatures and produced onshore.
As we've seen with the disorganised rollout in the US, the effectiveness of a vaccine is just one factor in whether a vaccination program will be successful. But it appears to be an area the US has nailed.
Loading...The takeaways
The countries which have achieved greater rates of vaccine coverage have a few things in common. They went hard and early on procuring doses, despite that being an economic gamble. They were quick to approve vaccines, and while that can carry risks, it has put them ahead of regions like the EU, which imposed more regulation and is significantly behind the UK in rolling out doses.
We've also seen the value of strong, well-coordinated and universal healthcare systems, which have allowed Israel, the UAE and the UK to avoid the pitfalls that the US experienced with its under-resourced, patchwork system.
Australia has committed to offering the vaccine free to anyone who wants it, and the strength of our public health system has already been demonstrated throughout the pandemic.
But to get the vaccine into people's arms, you ultimately need the vials themselves. Those countries which have had a secure, domestic supply have been able to race ahead. Again, this bodes well for Australia, with the bulk of our doses to be produced onshore.
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