Government needs to rethink its COVID-19 strategy

Future COVID-19 plans need to focus on resilience, sustainable development and to reappraise risk assessment procedures that have been relied upon, writes Dr Ted Christie.

MEDIA AND PUBLIC COMMENT on the global COVID-19 pandemic has triggered an ongoing controversy on the appropriate problem-solving pathway for Australia to adopt to effectively address the pandemic.

But has Australia really drifted into the outcome as described in this recent media critique?

‘Around the world, Australia has gone from hero to zero in our panicked handling of this pandemic and the lack of balanced analysis of the harm of lockdowns versus the harm of COVID-19.’

To be effective, any future national plan by the Government for Australia’s COVID-19 future should resonate with a vision for a resilient Australian society.

Achieving such a plan would require decision-making to be based on two cornerstones that are interdependent and mutually supporting:

  • for the Government to recognise the need for “resilience” as an outcome. Resilience is a unifying scientific concept having a long history of application in the management of natural and human systems following disturbance — for example, for human systems, a global pandemic. The concept of resilience is based on two phases having quite different goals: response to and recovery from the disturbance; and
  • for the Government to recognise that recovery from the COVID-19 pandemic is clearly a classic sustainable development problem to resolve — not simply a public health crisis.
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Response to the COVID-19 global pandemic

From the outset, the primary goal of initial actions and measures taken by the Government throughout Australia was to respond to the COVID-19 pandemic by managing infection, recovery and mortality rates based on epidemiological and public health scientific evidence within a risk analysis framework.

Public health actions and measures introduced during the response to the COVID-19 pandemic such as border closures, lockdowns, business restrictions, social distancing and mask-wearing sought to limit exposure by managing population risk to ensure quarantine. There would be little dispute that this was the appropriate response pathway to take at this time.

But these restrictive actions and measures led to adverse economic, social and cultural impacts and inequalities, igniting public controversy and protest.

The onset of COVID-19 lockdowns and the closure of borders led to:

‘…a massive negative and pervasive impact on Australia’s economic performance in 2020. Australia entered its first technical recession since 1991 and the underemployment rate soared to 7.5%.’

Since then, most attention has been given by the Government to resolve the adverse economic impacts.

However, the pandemic has also increased demands on mental health services and strengthening — notwithstanding an early warning made in May 2020 by the United Nations, specifically, the need for the global community to do much more to protect people facing mental health pressures due to COVID-19:

‘The U.N. noted that psychological problems such as depression and anxiety were significant causes of misery.’

In 2021, mental health issues have now come under far more intensive focus for their resolution in Australia. Also, many Australians have delayed or avoided healthcare appointments and tests during COVID-19, but are returning as pandemic restrictions ease.

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Transitioning to recovery from the COVID-19 pandemic

In transitioning from the response to the recovery phase, the vaccination rate will be the key to easing COVID-19 restrictions:

‘The Prime Minister says 70% of eligible Australians will need to be fully vaccinated against COVID-19 for the country to begin reopening and returning to normal and 80% to end lockdowns.’

The need for mass vaccination as the supply of vaccines ramps up should not be in dispute. However, achieving the targets for vaccination set by the Government has proved to be problematic.

Research by Essential Report (August 2021) into a range of issues related to mass COVID-19 vaccination in Australia found the general population was split on the question of the main barrier to vaccination:

  • ‘…just under half (48%) think it’s an unwillingness among people who are eligible for a COVID-19 vaccine to get vaccinated.’ The barrier of vaccine hesitancy refers to the delay in acceptance or refusal of vaccines despite the availability of vaccine services.
  • ‘…just over half (52%) think the biggest barrier is a shortage of supply of COVID-19 vaccines for people who are eligible and willing to get vaccinated.’ The ability of the Government to manage the logistics of delivering vaccines safely and competently is critical for maintaining public trust.

Where vaccination and health-related risks and decisions are matters of individual choice and responsibility, the factors that determine whether the problem of vaccine hesitancy may arise need to be understood.

“Complacency” is one factor if vaccination is not considered a necessary measure to prevent the risk of COVID-19 infection. The polar opposite to complacency is “collective responsibility”, or willingness to protect others by one’s own vaccination. It is commonly called “herd immunity” when enough people in a population have become immune to stop a disease to spread freely.

Public confidence and trust in decision-making by the Government that address community concerns on the need for COVID-19 vaccination has a significant role in offsetting vaccine hesitancy.

The trust-building approach taken within Australia to encourage the spread and uptake of COVID-19 vaccination within the community to offset vaccine hesitancy concerns was reliant on scientific risk assessment as the basis for better-informed decision-making by comparing the potential benefits against the risk of harm from COVID-19 vaccination.

But what may be an acceptable level of risk for COVID-19 vaccination for science – such as epidemiologists, clinicians or politicians – may be quite different from public opinion and community perceptions of vaccine risk.

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Vaccine hesitancy and risk communication

The Department of Health’s report titled ‘COVID-19 Vaccination — Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca’ (June 2021) is a good example of the role of science and the application of a technical health risk assessment for decision-making.

Vaccination with AstraZeneca may lead to a rare but menacing severe side effect — life-threatening blood clots.

The risk of a condition called thrombosis with thrombocytopenia syndrome (TTS) after AstraZeneca was assessed:

‘Current data indicates that TTS occurs in around two out of every 100,000 people who receive the first dose of COVID-19 Vaccine AstraZeneca. TTS appears to be far more rare following second doses, with data from the United Kingdom indicating a rate of 1.5 per million second doses.’

One comparison of health risks concluded that the risk of blood clotting from AstraZeneca vaccination was far lower compared to the fatality rates for COVID-19 itself — notwithstanding that fatality rates vary greatly by age, location and other factors.

At the end of the day, the practical problem for better-informed community decision-making goes beyond a scientific (or “technical”) risk assessment based on objective scientific data or predictions from mathematical models.

A technical risk assessment does not reflect how a particular risk is viewed when values and emotions come into play.

So, should risk appraisal – the steps to assess, evaluate, manage and communicate COVID-19 health risks – also account for community perceptions, concerns and opinions by what is termed a “concern assessment”.

This is a feature of the framework for risk appraisal applied by the International Risk Governance Council (IRGC) protocols. Under IRGC Governance protocols, concern assessment is just as necessary as the technical assessment and management of risk.

Risk appraisal includes both a risk assessment and concern assessment:

‘Risk assessment seeks to establish the technical link(s) between risk agent(s), cause(s) and consequence(s), specifying the probabilities (‘likelihood’) of occurrence. Concern assessment complements this information with insight from risk perception studies and interdisciplinary analyses of a risk’s social and economic implications to better understand the values and emotional issues that could be associated with a risk.’

Where risks and decisions are matters of individual choice and responsibility, a risk appraisal for COVID-19 health risks that included both a risk assessment and concern assessment would be an aid to offset vaccine hesitancy concerns and lead to better-informed decision-making.

There is a possibility that a community comparison of benefits and risks based on a technical risk assessment may ignite vaccine concerns that exist or create doubt about the vaccine — and so be a trigger for vaccine hesitancy. Risk appraisal based on both risk assessment and concern assessment would be advantageous in avoiding such an outcome.

A key question when comparing the benefits and risks of COVID-19 vaccination is what is an “acceptable level of risk” or “how safe is safe enough”? This question lies at the interface between science and politics and is referred to as a trans-scientific question — questions which can be asked of science and yet which cannot be answered by science.

Whether society considers a risk to be acceptable is, in part, influenced by perceptions of its impacts. Risk perception involves people’s feelings, beliefs, attitudes and judgements; it is at the core of understanding vaccine hesitancy.

Risk appraisal based on both risk assessment and concern assessment leads to better-informed decision-making to address the challenge to gain and maintain public trust and confidence in vaccination and COVID‑19 vaccines. Australia’s COVID-19 Vaccination report makes no mention of concern assessment.

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Recovery from the COVID-19 global pandemic — co-existence and sustainable development

In 2020, the World Health Organisation expressed the view that any goal to eliminate and eradicate the number of COVID-19 infections was unrealistic.

In 2021, it also seems unrealistic to hope that the world can rid itself of the COVID-19 virus based on having an effective vaccine.  

Instead, the more likely global position will be for the virus that causes COVID-19 to become endemic — that is, the virus will continue to circulate in pockets of the global population for years to come.

So, to achieve resilience, any plan by the Government to recover from the global pandemic must focus on a future in which it may be improbable to reduce COVID-19 health risks to a zero level. 

Co-existence with COVID-19 should be seen as the norm for a resilient society. Recovery from the pandemic also needs to be seen as a classic sustainable development problem for the Government to resolve.

A YouGov poll undertaken nationally for News Corp in August 2021 highlighted some of the current concerns Australians have following restrictions imposed in the response to the COVID-19 pandemic. These include the closure of businesses and unemployment, mental health, the persistence of infection and mortality in the community and social isolation through to negative long-term effects on children’s education.

The poll provides a window into understanding the political pressures for the challenge that lies ahead for the Government.

How is it possible to effectively balance COVID-19 health risk considerations against the adverse economic, social and cultural impacts and inequalities that have emerged from the response to the pandemic?

This challenge resonates with what is probably the most well-known and generally accepted guiding principle for achieving sustainable development:

‘Decision-making processes should effectively integrate both long and short-term economic, environmental, social and equity considerations.’

These multiple, competing considerations need to be balanced equitably and not be weighted in favour of one.

Equity is an accepted, key element for achieving sustainable development as it aims to minimise the extent to which costs and benefits are shared disproportionately between all sectors of society.

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For Australia, decision-makers should also be mindful to ensure that another of the guiding principles for sustainable development – endorsed by all levels of government in Australia by a landmark national environmental policy – is effectively applied during the recovery phase for COVID-19:

‘Decisions and actions should provide for broad community involvement on issues which affect them.’

Or, as the outcome document of the United Nations Conference on Sustainable Development (Rio de Janeiro, 2012) – The Future We Want – concluded, in reinforcing the original U.N.  Agenda 21 sustainable development plan of action (1992):

‘…opportunities for people to influence their lives and future, participate in decision-making and voice their concerns are fundamental for sustainable development.’

Finding sustainable solutions for the recovery phase from the COVID-19 pandemic will also require national governments to decide on an appropriate methodology for them to adopt.

Consideration should be given by the Government for adopting multi-objective analysis as a decision-making aid for finding sustainable solutions. It is a well-accepted, cross-disciplinary procedure for resolving public sector problems involving multiple and competing objectives — whether in environmental policy, water resources, energy or public health.

Some of the adverse impacts and inequalities in Australia’s response to COVID-19 that exist today were reasonably foreseeable. Some may be unintended outcomes. Overall, there will be no short-term fix as a long-term solution seems inevitable.

A priority for decision-makers during the recovery phase from the pandemic must be the need for sustainable solutions to resonate with the principle of intergenerational equity — a concept of fairness between generations. The principle is the foundation for sustainable development.

Any failure in this regard may well raise the claim that a Marxian philosophy prevailed for decision-making in the recovery phase from the COVID-19 pandemic when it came to effectively address the needs for intergenerational equity and sustainable development.

The reason? The following statement loosely attributed to Groucho Marx:

‘Why should I care about future generations — what have they ever done for me?’

Dr Ted Christie‘s professional expertise and interests are alternative dispute resolution(ADR), effective public participation and environmental law and science. In 2001 he was awarded the Centenary Medal for long and distinguished services to the community related to education and the law. To read more from Dr Christie, click here.

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