Chief Medical Officer’s press conference about COVID-19 on 19 January 2021

Date published:
19 January 2021
Media type:
Transcript
Audience:
General public
PAUL KELLY:

Good afternoon all and welcome to the COVID-19 outbreak from Canberra, the national perspective. Very good news again today, another day in Australia of zero cases and no deaths. We haven't had a death for some months. So that makes four out of the last five days we've had zero cases, locally acquired cases, in Australia, which is a huge contrast to the rest of the world, which is still absolutely in the middle of a global pandemic, and we should remember that. In that same period of time in the last five days, there's been 300,000 cases and 50,000 deaths internationally. So we're in a very good position here in Australia.

I think- I also want to talk today about the fact that there is no hotspots in Australia, at least from the Commonwealth perspective, and indeed by any way of looking at hotspots; there just aren't any. So we're in a good position. We are still of course continuing to see cases in hotel quarantine, and that relates to the overseas situation. As long as we're having Australians coming home and others coming into the country, we will be seeing people in hotel quarantine with COVID-19.

I just want to talk also about the vaccine. There's been quite a lot of reports about the unfortunate events that have been happening in Norway, and also in fact in Germany, in relation to the Pfizer vaccine and its use in the very frail, very old members of the population, particularly in aged care facilities in those countries. We're in direct conversation, and certainly the TGA, Professor John Skerrit, is in direct conversation with his counterparts in Norway and in the European Medicines Authority about these matters. We know that Norway is looking into those issues very directly and very specifically for each of those cases.

At the moment, they do point out, and this is publicly available information as well, that in Norway in a normal week, 400 people do pass away in their aged care facilities. And so that has to be put into the context of what has happened after people have received vaccines. And that needs to be looked at very carefully, and the TGA will of course take that information into account in their assessment in the coming days and weeks. This is exactly of course the reason why [audio skip] of the good situation we're in in Australia from the epidemiology of the disease. We can actually wait and have waited to do a full assessment, not only at the clinical trial information, but also the information that's coming from those other countries that are rolling out the Pfizer vaccine, the AstraZeneca vaccine, the Moderna vaccine, and others. So that will be taken into account. At this stage, it doesn't- it won't delay that process. But the TGA is doing its due diligence as we expect them to do as the independent regulator of these matters.

So we have a balanced portfolio of vaccines that we're working through. Pfizer will most likely be the first to get approval, but that's subject to the TGA's very detailed look at that vaccine and their assessment. We have the AstraZeneca vaccine as well, which as we know, we're certainly not alone in the world for pre-ordering that particular vaccine, 100 million in the UK, 200 million in China, 300 million in the US, 400 million in the EU, and 500 million in India. So there are literally over 1 billion doses that have been pre-ordered around the world of the AstraZeneca vaccine, and that's very actively being considered both by our expert advisory group, ATAGI, as well as the way that that's playing into the TGA assessment in relation to that vaccine. So we have that balanced portfolio, and they're on track for the starting vaccination in Australia next month, subject of course to the TGA approval and to the supply of those products into Australia.

I just wanted to make one other point about vaccines, and that's the concept of vaccine effectiveness. Vaccination effectiveness is more than just the efficacy of the vaccines; that might just sound like words, but it is a very important concept. So there was some debate last week about whether the AstraZeneca vaccine was somehow less- had less effectiveness than the Pfizer vaccine - that's related to the phase three clinical trials. We talked about that last week. But the efficacy of the vaccine is only one component, yet there are three components to effectiveness for vaccination programs. One of them is the efficacy of the vaccine. There's also the duration of effect of the vaccine, and my esteemed colleague, Allen Cheng, made some comments on that in The Australian newspaper today. We don't know how long these vaccines are effective for because they're so new. So whether we need to do a booster in some point remains to be seen. So, efficacy, the duration of effect, and the third one is the coverage. We need to give as many vaccines out into the community as possible. And if we don't do that, then the effectiveness will be indeed affected.

Lastly, I just want to make an announcement which is not COVID related. So there's a press release today about new labelling for antibiotics in Australia. Whilst we're in the midst of a COVID-19 pandemic, we have to remember there are other issues that are important for the health of the nation and the health of the world, in fact. And anti-microbial resistance, especially antibiotic resistance, is one of the biggest public health issues that we face. And so the Pharmaceutical Society of Australia is to be applauded for changing the way pharmacists are labelling antibiotics that they dispense. And this is to support best practice of anti-microbial prescribing and their use. And so, from this month, antibiotics dispensed by Australian pharmacists will be labelled with instructions that they are to be taken for a prescribed and definite number of days, according to the prescriber's instructions. Not the whole package necessarily, but what is necessary, and only what is necessary for that antibiotic to work effectively. And so that will be something that will be rolled out in Australia this year to address- as one of the issues that we're addressing which isn't COVID related.

So I'm happy to go to questions now. Claire, do you want to start?

QUESTION:

Professor Kelly, there's been a report today from the independent panel [indistinct]… origins and handling of COVID. It was critical of China and the WHO for being slow to act over December, January last year. And it also recommended an overhaul of the way that information is shared from labs to the WHO, and then to government officials such as yourself. What can Australia take from those were pretty harsh findings? And do you think it validates our call for that independent panel to be created in the first place?

PAUL KELLY:

Well, I certainly welcome the WHO independent panel. A shout-out to Dominic Dwyer, who's the Australian microbiologist who's on that- is in China right now from Westmead in Sydney. So, they're doing important work. It's very important to see- to learn whatever we can from this pandemic. And one of the issues that was raised early on was about delays in notification, and so getting to work out why that was the case and what we can do to improve into the future, more importantly, would be the key there. I'm sure everyone remembers what- the team is now in Hubei province, I understand, in Wuhan. And I think people will remember very vividly the scenes we saw a year ago in Wuhan, and how that transpired for the people of that city. They're back to normal living now, and so I think that whilst there is criticism of China [audio skip] I think there's also a lot we can learn from the Chinese response. So they had a terrible situation there which they've been able to come through.

QUESTION:

The Director-General of the WHO gave a speech yesterday about vaccine access, and he was saying that some countries are going around COVAX, driving up prices intending to jump to the front of the queue and called for rich nations to [inaudible] more resources and more help to COVAX. Is that something that you or the Department are worried about as well? Is that something you think is happening? And secondly, can you remind us what Australia is actually doing as part of the international agreement(*)? [Indistinct] you mentioned last week that we could be looking to actually get some supplies out of COVAX for Australia.

PAUL KELLY:

Yeah, so we were a very early adopter of the COVAX initiative, and that amongst other mechanisms have been a demonstration of our commitment to a global response to a global pandemic. And I think we absolutely need to remember that. And Australia is committed to supporting particularly the Pacific and Southeast Asian countries in our region with exactly that issue. The COVAX initiative is an interesting one. It's essentially a buyers' club, so using the ability to have large amounts of money to purchase vaccines, it allows us to spread our risk in a sense, in diversifying our portfolio of vaccines for Australia, but also supports exactly that global effort to allow large numbers of vaccinations at an affordable price for countries that would otherwise not be able to afford them. So, I think in a global pandemic a virus problem in any country is a virus problem for the world. And so, we are not out of this global pandemic unless we really address that, so I support the WHO's call for consideration of that.

QUESTION:

Just a couple. Obviously, the [indistinct] comments about travel probably not being likely this year, you know, caused a bit of a stir. In your opinion, are you of the same view, that we're probably not going to see international travel this year? And secondly, regarding vaccinations, obviously those that have died after a vaccination are elderly and frail. But based on our vaccination strategy, they're also- you know, the over 75's and so on, they're the sort of first people that we've said we want to vaccinate. How are you reconciling that? What are sort of considerations from- you know, the medical board, are you guys considering when looking at those risks and needs?

PAUL KELLY:

So, firstly, on travel, yes, I think we have to be very careful - and we have said this on many occasions, I have certainly said it - the first vaccinations, as they roll out in a few weeks' time in Australia, it's not going to change everything back to normal. So, there will be a process through 2021 of returning to some sort of normal. I think it relates to the previous question about the global pandemic everywhere, and particularly outside of Australia. We are in such an envious position at the moment compared with the rest of the world. And so, unfortunately, I think international borders changes are probably going to be one of the last things to change rather than the first. And the other part of the question?

QUESTION:

The other question regarding how the elderly [inaudible]…

PAUL KELLY:

Yes, so that is a very tricky balance. So, I think we know that elderly people, as is the case in Norway, elderly people that are in aged care facilities are towards the end of their life, and that is why they are in that situation, often. So, we know from our own data from the Australian pandemic of those just over 900 people that have died, they have mostly been in the very elderly group, so they are of the greatest risk of severe infection. And in fact, the mortality rate is very high once you get over 80 or over 90 if you get COVID. So, it's that risk balance equation which the TGA will need to do around that- which people you should exclude from the vaccine.

QUESTION:

Do you think there might be a reconsideration about the very, very elderly getting that vaccine? Or at least, being one of the very, very first to get the vaccine.

PAUL KELLY:

So, they are beyond doubt the ones that are most likely to get severe infection, and they, as we know, both the Pfizer and the AstraZeneca vaccine have been shown to prevent severe infection. And so, there's a balance there as to whether- who should be excluded, and that's exactly the sort of thing that the TGA will advise us on before it is fully regulated.

QUESTION:

What have you been told- as you've said, you've been in conversation with the Norwegian health authorities and the EU authorities. What have they told you about those people that have died? Apart from being frail, do they have other specific conditions that then comes into that consideration around [indistinct]?

PAUL KELLY:

So, I don't have absolutely sort of detailed information on each of the patients, but in general terms they were very old, they were frail, some of them were basically terminally ill. They appeared that they- at least some of them have had the types of side effect of the Pfizer vaccine that we know about already from the clinical trials - so fever, diarrhoea, not eating, not drinking. And so, if people are very frail to begin with, then those sort of things can be serious in that type of situation. But as I say, the Norwegians are doing their due diligence in relation to that and going through every single one of those deaths and looking at them very carefully and we will have access to that information.

QUESTION:

Part of the reason we know about these deaths and figures is that Norway is doing a report every week of those. Will we see a similar thing here in Australia where every week we'll get a report about any adverse effects of people that have been vaccinated?

PAUL KELLY:

We're certainly looking very closely at how we're going to absolutely have a very close eye on adverse events, that we have a very good system in Australia, several systems. So, some states have their own system, there is a national system as well, the TGA has a system. So, we're looking at ways that we can bring all that information together. I won't promise a weekly report but certainly frequent reports about that and demonstrating that we are on top of that issue is really important for confidence and we are committed to do that.

QUESTION:

Can I just ask a quick follow up on the international borders - regardless of the- or, perhaps despite the caution around looking at travel this year, is there scope to look at more bilateral arrangements such as Australia-New Zealand again, also noting that New Zealand is allowing Cook Islanders to come there, which potentially creates a chain through to Australia. Is there scope in those more limited parameters later on this year?

PAUL KELLY:

Absolutely, and I think the vaccine rollout will be a component of our considerations there. We have a very detailed country risk assessment which we've been asked to do; National Cabinet asked AHPPC specifically some time ago to do that for countries and to do exactly that sort of assessment, are there green zone countries that we can do. That was the assessment we did for New Zealand to start with and every week I reassess that. If something happens every day, I will assess that every day. But at least weekly I do a formal report to decide whether that should continue or not and we look at a range of details that come from the New Zealand Ministry of Health. And so, that's been very successful. We have had many tens of thousands of people have come across the ditch in the last few months, not a single case. So, that's a very strong indication of that approach, we have done similar country risk assessments in a detailed way for many of the Pacific Islands. That's playing into the discussions around the Pacific Labour Scheme, for example, and what is the risk there. We haven't found another green country at this stage, but there are some that are very low risk and that is playing into our discussions about how people from some of those countries should be quarantined to make sure it is safe.

QUESTION:

So, there could be earlier progress with some Pacific countries than the international border more broadly? That's still a fair [indistinct]?

PAUL KELLY:

We are definitely open to other bubbles as they were called, and we certainly would welcome the New Zealanders to look at our own epidemiological situation and maybe have something a bit more reciprocal than we've currently got at this stage. Anyone- any New Zealanders going back to New Zealand or Australians going to New Zealand would still have to undergo a two week quarantine period. But we are in close discussions with our New Zealand colleagues all the time on that one.

I'll just go to the phone. Andrew Tillett?

QUESTION:

Yeah, how are you going? Just sticking with the international travel theme, what are the criteria that you're looking at to reopen the borders? Is it vaccination rates in Australia and overseas? What's the sort of critical mass that you'd need to get- would make you open a border? Also given that we might be having a prolonged period of requiring quarantining, two weeks' quarantine upon return, do we need to revisit or maybe go back to the Halton inquiry recommendations and look at a home quarantining setup, given that we're going to be dealing with this maybe for another 12 months?

PAUL KELLY:

So, I think it's a very dynamic space. Certainly, firstly on the Halton review, we have- we will be reporting back because we have been asked to- the National Cabinet not this Friday but on 5 January about the recommendations under the Halton review. I think we will find and we have asked each of the states and territories to assist with that through to the AHPPC. I'm pretty sure we will find that we have done all of those things, or most of those recommendations from the Halton review, plus many others that have come from the Coates inquiry in Victoria, and recent experience in South Australia, in Queensland, in New South Wales, to see how we can strengthen quarantine.

The issue of home quarantine, or alternatives to quarantine or shortened quarantine was taken to National Cabinet I believe in November - it might've been in October - and at that time, there was a very strong sense in the National Cabinet that they didn't want to go- it was hotel quarantine was what they wanted except for very specific groups who we've seen some alternative arrangements, for example with farm labourers in some states. In terms of how that might change into the future, yes of course a large and effective rollout of vaccination in Australia would increase our protection which would be of value. The same for other countries if they have strong vaccination programs. We are already seeing in some countries that have rolled out vaccinations in recent weeks, a drop in the number of cases they are seeing. And in one case, particularly in Israel, we're already seeing a significant decrease in hospitalisations and so the severe end of the spectrum is already happening. So vaccination will play a part for this wide range of information that we look at to make those assessments.

QUESTION:

Is there a critical mass that you need though on the- do you need like, 50 per cent, 75 per cent of the population vaccinated to sort of feel comfortable with that sort of stuff?

PAUL KELLY:

So I'm not going to speculate on a number, it's only one of the things that we've been looking at in any case.

Claire?

QUESTION:

Professor Kelly, I think this week GPs were being asked to start signing up and registering their interest to administer the vaccines. Can you give an update on where that's at and will there be any training or resources? What is that program, and will it be most likely for the AstraZeneca vaccine?

PAUL KELLY:

So yes, we have started- well some weeks ago or more than a month ago we started discussions with states and territories, in terms of their involvement with the rollout of vaccination program, particularly the Pfizer hubs that we've talked about which will mostly be run by states and territories and probably mostly out of major hospitals. The next phase is looking at other- expanding that availability, probably most likely with the AstraZeneca vaccine, assuming that that is found to be- is regulated by the TGA and allowed to be used in Australia. The reason for that is because it doesn't need to be kept at that very cold temperature and the logistics is much easier. It's much more akin to the usual vaccination program in GPs fridges for example. So yes. we have put out expressions of interest for GPs. We had a discussion yesterday with the peak bodies, the College of Physicians, the AMA and the Australian rural doctors' groups. So, we have, about how might that work. So that's work that's going on now.

QUESTION:

On the TGA, the TGA is currently running a rolling review of the Johnson and Johnson vaccine. And that company says they would hope that it will be approved here in Australia. Are there other vaccines the TGA is also running similar rolling reviews of? And would you or would you expect that we could hope Australia would- TGA would approve further vaccines in addition to the three that we're already looking at?

PAUL KELLY:

So they're the three at the moment. Novavax, which is the other one we have a pre purchase agreement on has also approached the TGA to start that process. But that's just kicking off now. The TGA is open to any vaccine sponsor that wants to come and talk to them. And they've talked to dozens of vaccine sponsors. This is a two-way process but in fact, the way the TGA works is it has to be initiated by the sponsor or the company that's associated with that vaccine. So we're open to those things definitely.

QUESTION:

As you're developing the time frames for the rollouts to different cohorts of the community, we know children are not a priority at all but is there a time- are they being factored in for the rollout at the end of the process? And if so, what sort of timeframe would that- would you anticipate that would be?

PAUL KELLY:

So at the moment, the data on the vaccines, the two particular ones that are first off the rank- off the TGA procedure now are- they haven't got any data on children. So the Pfizer vaccine has just started doing some trials in down to 12 years old, I believe. But at the moment, there's nothing above 18. So I would imagine, and it's the TGAs prerogative to go through this, but I imagine that the first approvals will be only for adults. But I expect as the year goes through, we will get more information on children. And if that's the case, then we will factor that in later in the year.

QUESTION:

Would having clinical trials on children be a prerequisite from your point of view in wanting to roll out a vaccine to children? Would there be a circumstance under which you would be happy to see a vaccine rolled out if there wasn't any data on having involved children in a trial process?

PAUL KELLY:

So we'd need regulatory approval and that would require data either from clinical trials or elsewhere to allow that to happen. I think particularly the older age group of children, so 16 to 18 year olds would be important to consider because we know that they are at higher risk then than younger children in terms of getting the COVID-19 disease. And so they're the most likely. But I think we're getting ahead of ourselves. We've got our priority groups that we need to concentrate on first of all, and then then into the rest of the adult population. And then towards the end of the year, if we have the data and the regulatory approval, we'll consider it for children as well.

QUESTION:

If I can just ask on parliament, obviously [indistinct] there's been numerous outbreaks. We've had a new more infectious strain detected in Queensland and so on. Is the first week of sitting that's coming up- do we know what that's going to look like yet? Are you going to be providing any advice to the PM and so on? Can you give us an idea of what that's going to be like?

PAUL KELLY:

So we've had detailed discussions with the presiding officers. That's the speaker of the House and the president of the Senate. They are, in fact, the ones that decide the rules for parliament. And we've had a very good and open arrangement and discussions with them right throughout the pandemic. And so we now have that sorted out for the first sitting week, which is next week, I think. And it's mainly related to the certain postcodes in Sydney that are still of concern.

QUESTION:

Will there be mask wearing, mandatory mask wearing for any people from certain areas?

PAUL KELLY:

So really there is a restriction on people coming from certain parts of Sydney. And that's been signed off between myself and the ACT Chief Health Officer. And we've got that arrangement and agreement with the presiding officers about how that should work.

QUESTION:

You did say earlier that there's not really any hotspots that anyone would regard. So is it still really necessary to have those provisions of people coming from those areas of western Sydney, given that, as you said, there's not really an issue in those locations?

PAUL KELLY:

So I mean, it's looking very positive in Sydney. But I think- when we started to think about this some weeks ago and so we took into account what the situation was there. The Chief Health Officer in New South Wales, Kerry Chant and I speak at least once a day and she still is concerned about that. That's why that area of Sydney, that's why they're really calling and I'll echo those calls for anyone who's sick or is being asked to get tested to get tested today. Don't delay. And the quicker we can make sure that there are no further cases in that area, the sooner we could remove all restrictions, which would be fantastic.

Just last question.

QUESTION:

Professor Kelly, this week marks one year since the first case of COVID came to Australia. I guess reflecting on that, you said that we're in a very different position to everywhere else in the world. What's your reflections on, I guess, what we've done well and what you think we could have done differently?

PAUL KELLY:

That will be a matter for a book, I think at some point. But look, I think we are just in a remarkably good position. We've had our really challenging moments and we'll all remember the terrible winter that our friends and family and colleagues spent in Melbourne. That was an unfortunate event. And of all the things that we've gone through, I think that was the one where we've learnt the most lessons about what to do next. I think since then we've learnt a hell of a lot about what to do, how quickly to go, how fast to go to, to bring in those public health measures. To strengthen all of the public health measures we have, have been really important.

But I must say that it's been an absolute privilege to be part of this response because I think the one thing we can be very proud of, of all Australians pulling together, but also aware of the governments, both at the national level and in the states and territories, really listening to that evidence based advice. And I think that's been something that really contrasts us with many other parts of the world and has really stood us in good stead and continues to do so. And next week or the week after that, or some weeks in the future, we will be hearing more about approvals of the vaccines, and that'll be the next phase.

Thanks very much.