When you're on a long journey through a desert, it's easy to see an oasis ahead, even when there is only dry sand.
The national cabinet is pinning its hopes on 70 per cent and 80 per cent COVID-19 vaccination rates before Australia starts to reopen in earnest. These targets have limited epidemiological significance and will leave many millions of Australians vulnerable to long-term health effects and even death.
However, achieving these targets could allow the federal government to shift the perception of responsibility for an inevitable increase in COVID-19 cases from itself to those most likely to get sick or die - the unvaccinated.
Most Australians are immunologically naive to the virus. They have not received vaccines or become ill with COVID-19. Since the Delta strain is so easily transmitted, we'd probably need at least 90 per cent of the total population to have immunity to the virus to achieve herd immunity. The target of 80 per cent of eligible adults does not include children and young people, or adults who cannot have the vaccine for medical reasons, and is closer to only 60 per cent of the total population.
Every person vaccinated on the way to 80 per cent and beyond will help reduce the risk of overwhelming our health system, and is a small victory in reducing the likelihood of widespread lockdowns - but while vaccination dramatically reduces individual risk, there is nothing magical about our current targets.
The risk of the 80 per cent target is that when it is achieved, we decide that people have had adequate opportunity for vaccination. If they get sick, it is their own fault. Already, when COVID-19 leads to fatalities, governments often report people's vaccination status. While the intent is to publicly communicate the importance of vaccination, the unintended consequence is to make victim-blaming more likely.
Vaccination is a race, but we should not condemn the slowest 20 per cent. Many will not be firm anti-vaxxers, just those who are less able to access vaccination or who have found the messaging around vaccination confusing. Who can blame them when eligibility requirements have evolved so often, the advice on Astra Zeneca has changed dramatically, and some in Parliament openly attack basic epidemiological advice?
The job of governments and society will be to bring this group along, including with targeted messaging and specific campaigns to facilitate vaccination. We need to give everyone a fair go before life goes all the way back to normal.
The vaccination rollout is already leaving some priority populations behind. Given our nation's colonial history, including forced medical incarceration, it is unsurprising that Aboriginal and Torres Strait Islander communities might be less trusting of government health advice. Vaccination rates are indeed lower for this priority group, and this could increase the life expectancy gap if Australia simply opens up when we reach the 80 per cent target.
Whether Aboriginal and Torres Strait Islander communities are provided the time and resources to implement their own, locally tailored vaccination campaigns will be a true test of the government's commitment to closing the gap.
Other priority groups have their own barriers. These include language, employers that don't support vaccination with time off, and difficulty navigating the system, especially for those with limited access to the internet, phone, or transport. There is a clear class element in access to vaccination.
The ACT government is to be congratulated for its efforts to blunt this effect, and is a model to some other jurisdictions.
There is a legitimate discussion to be had about balancing mental health and COVID-19 infection costs when 80 per cent of Australians are vaccinated. Options beyond lockdown are many, and include mandatory masks in some settings, continued contact tracing and isolation, density limits on gatherings, and restrictions on travel.
Those of us fortunate enough to be vaccinated, the privileged, should be patient, not punitive.
- Dr Devin Bowles is ACT branch president of the Public Health Association of Australia and chief executive of the Alcohol, Tobacco & Other Drugs Association ACT.