In COVID-19, is Eighty Percent vaxxed the same everywhere and for everyone? If not, how do we make sure it becomes so?

The NSW government has made much of the promise that something good will happen when localities achieve 80% of second jabs of eligible people. However not all numbers are equal. It may be rather easier to reach the absolute number of 80% of the population over 12 years of age in some places than others. The difference depends on what proportion of the total population in each local government area (LGA) in NSW is over 12 years of age. Sitting behind the 80% figure may be an assumption that every LGA has a similar age and socio-cultural profile. 

They do not, and the vulnerable have very different degrees and causes of vulnerability – primarily determined by the level of crowding in residential accommodation, which is a function of income and to some extent culture (attitudes to having  large families), and place in the life course. In Australia these factors are found most commonly in multicultural and Indigenous communities. So clear multicultural and Indigenous equity policies that identify and respond to cultural diversity pro-actively rather than reactively, are crucial planks in the policy process. Unfortunately those planks are too often missing or barely present, often  attached as an afterthought in response to some emergent crisis.

Not only does every LGA have a different profile, but also the LGAs “of concern” during Delta have higher proportions of people under 12, and of culturally diverse or Indigenous backgrounds – as well as many more reservoirs of infection into which everyone can be dipped.  Let’s look at Blacktown in Sydney’s west, and Northern Beaches across the Harbour along the coast to the north, two very different places with different vulnerability factors, different outcomes, and different prospects. At the turn of 2021, Northern Beaches had an intensive outbreak of an earlier viral mutation; it faced local lockdown, divided at the bridge over the Narrabeen Lakes. The lockdown lasted a few weeks until total suppression was achieved. Blacktown nine months later as one of the most intensive areas of concern is part of a total lockdown zone.

When “80%” of Blacktown’s over twelve population is doubled jabbed, actually only 64% of the population will have been inoculated. However in Northern Beaches, also a large LGA but not one of concern, when 80% of the over 12s are inoculated this will mean 68% of the population will have been double jabbed. For Blacktown to reach the underlying level that Northern Beaches gets to with 80% will require its residents to achieve 85.4%.

Here’s the table that shows how this works.

LocalityAge group2016 N2016 %2021 N2021 %
Blacktown0-126690019.2%8090019.8%
 13+28108380.8%33142880.2%
 Total347983100%412328100%
Northern 0-124410016.6%4420016%
Beaches13+22136583.4%23070084%
 Total265465100%274900100%

Given the fetish for numerical magic that now pervades political discourse, the model proposed by the NSW government in fact creates a reservoir proportionately 25% larger of unvaccinated children in Blacktown compared with Northern Beaches. Furthermore this reservoir is contained in dwellings that are more overcrowded, poorer, less well ventilated, and with adults who are forced to travel for work, if they are lucky enough to have it. While an emotionally lacerated and more financially stressed western suburbs population surges towards vaccination as a promoted panacea for their woes, in fact to achieve an outcome that will work for them at the 80% level will demand a higher real world effort than they believe they are being called upon to make. In the unvaccinated pool may well be large numbers of the elderly, refugees and asylum seekers, and those with low levels of English competence and mother tongue literacy.

But does this matter? Some commentators claim that only 2% of under twelves who might get infected will get “very sick”. Sounds small, but apart from not knowing how many of the unvaccinated will get sick if exposed, the ones who do get sick can get seriously unwell – with a potentially endless long COVID post- viral scenario affecting them significantly. If ten percent of the under twelves are infected (a very conservative count if they are the vast majority of the reservoirs of potential targets for a very successful virus), then in Blacktown that will be 8000 or so – of whom 150 or more would be seriously affected.

The twenty percent of over 12s who are not vaxxed at 80% (or the even more scary 30% at 70% first proposed October relief from the lockdown) make up from 66,000 to 100,000 in Blacktown. So if we have 80% as our goal (and it has been reported that NSW Health is trying to convince science-hesitant politicians to ensure 85% are double-vaxxed) then the pool of unvaxxed at opening up in Blacktown will be about 132,000, half of whom will be kids under twelve. So ultimately 80% of “adults” defined as over 12, is 60% of the population. There is no way that figure can ensure a freedom of movement as now is promised. Rather it will ensure, at a daily conservative  .05% infection rate and no break through in inoculated people, that about 60 cases will occur, with up to three hospitalisations a day, and probably one death a week, depending on age and co-morbidities.

We need to recognise that Blacktown, a hub for Indian communities among many others, has been extremely active in seeking vaccination since Pfizer has been made available ; its residents may indeed exceed the 80% goal (at writing they are at 86% on first jab – over sixteens, so about 60% of the population overall at the moment). Such local communities will need to “go for gold” (over 90% of the over twelves) if they wish to avoid the inevitable local lockdowns that are a predictable part of the opening-up policy of the NSW government. They will also need sturdy local paediatric intensive care facilities, and an expensive and extensive renovation program for local schools to ensure high levels of ventilation, HEPA filters and social distancing strategies in classrooms. However with tens of thousands of unvaccinated adults exposed to viral attack whenever they leave home, and bringing it back into homes with children when they return, the rosy future being painted may have a different hue when that time arrives.  If the 80% figure was of the whole population (essentially meaning all adults over 12 are doubled jabbed), then the desired “herd immunity” saturation for the vaccine might be achieved and the children, potential carriers and victims, more effectively protected. 

The need to keep testing and then tracing infected people underpins the pathways we have been promised. The Australian testing environment demonstrates the craziness and the contradictions of our history as a capitalist federation which promotes itself as the global multicultural success story. In each state testing can be carried out in at least three different institutional frameworks, with only a minimal data set collected across all of them. The Commonwealth cannot require the states to do anything in this regard – until infection is determined when notification is mandated through an agreement between the jurisdictions (all of which have to agree if anything is to be changed). Notification only requires name, age, gender and location. If one is tested at a Commonwealth respiratory clinic (essentially a GP clinic specially funded by the Commonwealth) then data can be collected on language and country of birth if the patient agrees. This data is spasmodically collected and is not processed for immediate use by public health agencies. Private testing agencies and private GP clinics do not regularly collect this information because it is not mandated so that most commercial software does not have the capacity, and no one has decided to assert the authority to require it to do so. The states have differing policies in this regard at their testing locations, where it is usually only at the second stage, tracing of infected cases and their close contacts, that preferred language is requested, if an interpreter is thought to be required. There is no sign that these data are collected, collated or used.

Ultimately we are not well prepared for the implications of the current road plans out of lockdowns. Our testing systems are dilapidated, unintegrated and deficient in key data needed to ensure we stay ahead of the curve. It is possible to overcome these problems – however they have to be recognised and addressed. This will not be an expensive exercise compared with the handouts to major employers provided during Jobkeeper,  yet when achieved the results will be salutary and valuable in ensuring future well-being.  It would be great if there were some evidence of bravery among our leadership in this regard.

In NSW the State Government notes that “work is being done”  to integrate the vaccine status of people with their ServiceNSW profile so that the QR code process can automatically capture this information – a sort of vaccine passport that will increasingly be required to enter post 70% public places. Each jurisdiction however is playing its own game, which could all be standardised around the most effective solution.  We would also need to ensure asylum seekers, temporary visa holders and people with neither codes nor smart phones were included. If as part of the same exercise the language people speak at home, their country of birth and their arrival year in Australia were also entered (just once), and the QR codes were adapted to be used in all testing regimes in the state, then an almost instantaneous picture of the patterns of testing would be available.

As well, languages required for communication would be known ahead of any surges, with both text and audio messages being sent to appropriate language speakers. Locality by locality, age group by age group, language community by community, the front line public health workers would know the groups in danger of missing testing, of missing vaccinations, and to some extent their patterns of movement and contact.

We already have a surveillance system in place, but it operates erratically, four days or more in arrears, and with no community content. It’s time that we became the successful multicultural nation our government claims we are, by foregrounding cultural diversity and Indigeneity in our strategic thinking, saving lives and livelihoods in the process.

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