Our leaders’ deadly denialism

By Gabrielle Babbington 

Your jabs protect you, not others; the vaccines stop severe cases, but not new cases. These rules of thumb are backed by mounting evidence that the Australian establishment refuses to acknowledge. 

The data that clearly shows COVID-19 vaccines do not stop the spread of the Delta variant came out before the Doherty Institute modelling that assumes the exact opposite, and falsely promises a safe return to near-normal. Now, Australians are in for either a big letdown, or an even bigger catastrophe. If nothing changes, the people who need their jabs the most will be the last ones to get access to them. 

“These vaccines do not break the lines of transmission,” said virologist Dr Gary Grohmann, former longtime head of immunobiology at Australia’s drug regulator, the Therapeutic Goods Administration, and now the go-to expert for fellow experts, and vaccine advisor to the World Health Organisation. “We’re not thinking straight,” Dr Grohmann said of Australia’s roadmap out  of lockdowns, which is based on the Doherty modelling. “It’s absolutely dumb.” 

The terribly inconvenient truth

Having vaccines that stem the tide of severe and fatal COVID-19 is as good as it gets, most experts worldwide now concede. Professor Sir Andrew Pollard, who led the team that created the Oxford-AstraZeneca vaccine, recently told a UK parliamentary inquiry that mass vaccination campaigns would not stop the spread of COVID-19, because “the Delta variant will still infect people who have been vaccinated”. He referred to herd immunity (when the vaccinated many prevent infection in the unvaccinated few) as “mythical”, and said it was “not a possibility”. 

Last month’s data illustrates his point. In Singapore, where about 80 percent of the eligible population are vaccinated, three-quarters of the Delta cases were in vaccinated people (almost half were fully vaccinated). Likewise, during a Delta outbreak in Massachusetts in the US, where about 70 percent of eligible adults are vaccinated, about three-quarters of the COVID-19 cases were in fully vaccinated people. 

The Doherty Institute modelling is based on the underlying assumptions that, not only do the vaccines stop most people getting COVID-19, but the few vaccinated people who do still get it will be much less likely to spread it than unvaccinated people. But neither of these things are true. “Vaccinated people infected with Delta can transmit the virus,” because they have a similar viral load to that of unvaccinated people, Dr Rochelle Walensky, director of the US Centers for Disease Control and Prevention (CDC), said. Several studies back her up on this. The CDC now recommends wearing face masks indoors “to ensure the vaccinated public would not unknowingly transmit virus to others”. 

(By the way, the purpose of face masks is to stop us sharing germs we might not know we have – they protect others, not ourselves. If you wear a face mask with a valve, or pop your nose out of the top of your mask, you render it useless, as it cannot then trap any virus you might unwittingly exhale. “The evidence is quite thin that a face mask will stop you getting the virus, but the evidence is reasonably good that a face mask stops you transmitting the virus, because your breath and saliva will hit the mask, and that will definitely halt any transmission through the air,” Dr Grohmann said.)

Delta has run rampant in Israel, despite almost 80 percent of the eligible population being vaccinated, and the reintroduction of public health measures like testing, tracing, isolating, quarantining, and wearing face masks indoors. Israel is mostly using the Pfizer vaccines, and government number-crunching on more than 11,000 new cases between June 20 and July 17 found Pfizer’s real world performance, or effectiveness, against the Delta strain had dropped to about 40 percent – that is, there were only 40 percent fewer symptomatic cases of COVID-19 in (mostly fully) vaccinated people, compared with unvaccinated people. The less recent the vaccinations, the less protection they offered against infection. Just how low vaccine effectiveness against infection would drop if asymptomatic infection was fully accounted for is anyone’s guess. 

Experts say the Israeli data is world class; it is backed by other studies with similar findings; it has made headlines in The New York Times and The Wall Street Journal; and it has been endorsed by international figures in medicine, such as Professor Eric Topol, director of Scripps Research Institute, and editor-in-chief of Medscape: “Israel is the model,” he told Science. “It’s a working experimental lab for us to learn from.” But the Israeli data is terribly inconvenient, and it was “met with disbelief” by some, Professor Topol tweeted. 

The Doherty Institute’s modelling was released a week after the Israeli figures, but it ignores them, and stubbornly assumes vaccines stop the spread of COVID-19 by more than 85 percent – based on the combined results of two UK studies. One of these UK studies found Pfizer’s effectiveness against infection was 79 percent, and AstraZeneca’s was 60 percent – it included about 6000 Delta cases. The other study found vaccines halved the risk of household transmission – during the first two months of this year. 

Although these UK studies paint an optimistic picture, it is actually a mirage: they were conducted when the Alpha variant still predominated in the UK. Scientists say Delta is 30 to 100 percent more transmissible than Alpha, with consensus settling on about 60 percent. (Alpha, in turn, is 40 to 90 percent more transmissible than earlier strains.) Dr Grohmann said the outdated UK figures had compromised the Doherty modelling, which he said was “only as good as the data that goes into it”. 

The modelling assumes the vaccines are effective enough against infection and transmission to curb Delta outbreaks, if 80 percent of the eligible population are fully vaccinated – with public health measures lending a hand to bring case numbers down. But if vaccine effectiveness is cut by half, the modelling shows outbreaks will quickly get out of control, even when vaccination targets are met; and that lifting restrictions would see hospitals overrun, and deaths soar. Although the Doherty based their advice on the former scenario, our grim reality is the latter one. “It’s almost criminal, I’m flabbergasted,” Dr Grohmann told me. “I’m really shocked by the conclusions.” 

The overlooked sitting ducks

To save lives, Dr Grohmann wants to see at least 95 percent of high risk groups, and at least 80 percent of the eligible population, fully vaccinated before we start to live with COVID-19 – with a range of public health measures left in place to keep outbreaks under control. This call for twin vaccination targets is seconded by other Australian experts. 

In the UK, 95 percent of the vulnerable had received their first vaccine dose, and had their second dose booked-in, before lower risk groups (people aged below 50 with no high-risk health conditions) were eligible to receive theirs. The UK vaccination strategy did not target transmission; it was “targeted at providing direct protection to persons most at risk”. The UK also had the good sense to let GPs identify vulnerable patients, invite them in for jabs one-by-one, and chase any no-shows. But in Australia, there is no priority booking system for vulnerable patients, and all are left to their own devices. 

Australia’s plan to lift lockdowns, loosen restrictions, and open borders is bad news for those who are vulnerable to severe COVID-19, or serious complications from COVID-19 (or both). All things being equal, these sitting ducks are at the back of the queue to get vaccinated, despite early eligibility. Less than ten percent of First Nations people in NSW have been fully vaccinated, for example, compared with one third of people in the state overall.  

There are gaps in the data on vaccine uptake for other vulnerable groups, but this is health sociology 101: the same social disadvantage that leads to lifestyle diseases (which make people vulnerable to severe COVID-19) also results in poor access to up-to-date health information, healthcare services, and online vaccine booking systems – especially when there are language barriers too. We have a vaccine equity problem more than a vaccine hesitancy problem. 

These lifestyle diseases include hypertension, type 2 diabetes, obesity, high cholesterol, and heart disease. They are the underlying conditions most commonly seen in adults of any age who develop severe COVID-19, and they are overrepresented in poor, migrant, Indigenous, and elderly groups. Lifting restrictions before the vulnerable are fully vaccinated would benefit the privileged at the expense of those most at risk, experts warn. Dr Grohmann said low socioeconomic groups living in cities would be the hardest hit. 

Even in affluent areas, with high vaccine uptake and low case numbers, there are still sitting ducks. Lifestyle diseases are everywhere to varying degrees; and there are a raft of other illnesses that make patients vulnerable to being hit hard by COVID-19. These illnesses also complicate the quest for jabs: physical or mental impairment makes it harder to get out and about, and get vaccinated. 

Moreover, several doctors have told me that vulnerable patients (and members of their household) should avoid (indoor) mass vaccination hubs, where the risk of exposure to the coronavirus is too great, because so many people fail to wear their face masks properly. Instead, doctors say vulnerable patients should get their jabs in a clinic full of GPs, who know their complex medical histories, are anticipating any rare adverse reactions that might arise, and have stringent measures in place to keep COVID-19 out. 

Vulnerable people aged below 60 are particularly hamstrung, as Pfizer jabs came late to GP clinics, and appointments for first doses were booked solid until October from the outset – a much longer wait than lower risk groups have had at mass vaccination hubs. Again, the people who need their jabs the most are at the back of the queue. Until health authorities address these systemic failures, the vulnerable will be left exposed to social cleansing by default. 

The Doherty Institute refuses to budge from the false assumption that vaccines can stop the spread of Delta. “There is light at the end of the tunnel – once we achieve 70%-80% vaccination we will see less transmission of COVID-19,” the Doherty tweeted this week. In response, NSW Health has set up priority vaccination clinics for people aged 16 to 39 in COVID-19 hotspots, in a vain attempt to curb Delta, instead of prioritising vaccines for those most at risk.

Your jab will not protect the vulnerable, only theirs will. “The Government’s plan to learn to live with Covid cannot become a byword for abdicating responsibility to the most vulnerable,” said British Liberal Democrat MP, Layla Moran, chairwoman of the All-Party Parliamentary Group on Coronavirus. Our leaders would do well to listen to her. The more new data is released, the more stark their folly becomes. If they lift restrictions before the vulnerable are fully vaccinated, they will have blood on their hands. 

I’ve been investigating breakdowns in scientific rigour since the pandemic hit (you can read my special report here), and this is not the first bad call I’ve seen. It’s been more than 20 years since my health science degree, and more than 15 years since I swapped clinical practice for medical journalism. Never before have I seen health policy based on science denialism.