What we must do as aged care faces COVID threat

Disappointment and dismay are once again our response in aged care with news that the federal government rollout of the immunisation program for residents and staff is behind their initial schedule. To compound the situation, with another COVID outbreak and another lockdown in Victoria, there is a potential risk of deaths occurring in older people in aged care.

The words of our leaders ring hollow, and a task that they justifiably had given top priority was not met. The excuses and obfuscation around what happened has the same pattern we saw last year with the horrific situation of the second wave of COVID and the hundreds of deaths in aged care. It seems little has been learnt from the royal commission hearing about engaging with and respecting the value of staff and residents.

The first phase of Australia’s national COVID-19 vaccine rollout plan commenced to much fanfare in late February. It was a sound and appropriate decision that phase 1a prioritised aged care, where there are about 200,000 residents and about another 300,000 aged care staff. As we know almost 40 per cent of all COVID deaths across the world have been in aged care.

We know there were initial delays with obtaining the full 10 million Pfizer vaccine doses ordered. By early April the federal health department confirmed the government had received 1 million doses, more than enough to vaccinate every aged care resident in every home in Australia.

The government also had the huge advantage of knowing the location of all 2700 facilities where the residents live. The task ahead was transportation and logistics to handle the supply chain from where the vaccine is warehoused into the arm of a resident. That is, making sure there is a suitable workforce, equipment and transportation.

To achieve the full first vaccination in four weeks would require reaching 50,000 residents in 675 homes a week across Australia. When we divide that task according to each state and territory it becomes far more manageable, for instance Victoria would be reaching out to about 190 facilities each week. As the government health department has explained, there is only partial protection against COVID-19 after the first dose, and the best protection against the SARS-CoV-2 virus is about a week after the second dose.

We can speculate as to why the rollout been slower than initially planned, but it would be preferable to have the government and health department provide a full and frank explanation. The systemic failures in aged care are well documented in three separate royal commission reports highlighting understaffing and lack of appropriate skillset. There are also more than 800 different approved provider organisations that operate the care homes with whom the health department would need to negotiate and co-ordinate the rollout.

The rollout needed to be as fast as possible. Older people’s immune system is slower and less effective, so getting two doses of the vaccine into each resident is critical. We needed to vaccinate care workers as we know from last year, the entry of the virus into a care home typically occurs through staff with asymptomatic infection. Also, the longer the rollout took, the more time there was for new and more virulent strains to emerge.

A better future starts by investigating the causes and rectifying the failures of the recent past – which this government should examine with this rollout. Followed by planning for immunising the almost 60,000 new residents that enter aged care and new staff who enter that workforce. Strengthening the role of general practitioners in the vaccination program in care homes to improve uptake and addressing issues about vaccine hesitancy with residents, families and staff.

Hopefully, the situation in Victoria will be quickly contained. The multiple investigations into outbreaks last year at St Basil’s and Epping Gardens and the experience of the clinical and aged care staff provides a template for action. Perhaps the greatest remaining challenges are, encouraging and compensating staff to work at only one facility, which the federal government support, ensuring a sufficient workforce is in place and the co-ordination of effort between federal and state governments, health departments and the care home provider and hospitals.

We are far better prepared this time around to manage an outbreak. The frustration is with a better vaccination rollout we would not have needed to worry.

To that end, the federal government should release data informing the public of how many residents and staff have received two doses of the vaccine, how many care homes have achieved vaccination rates of 70 per cent or more of residents and staff. This will tell us how many individuals are protected from severe illness and how many care homes are protected from a large outbreak.

Joseph Ibrahim is a professor and head of the Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University.