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Senate Select Committee on COVID-19
23/07/2021
Australian Government’s response to the COVID-19 pandemic

BLEWITT, Ms Teena, Acting Deputy Coordinator General, National COVID Vaccine Taskforce, Department of Health

BLYTH, Dr Christopher, Co-Chair, Australian Technical Advisory Group on Immunisation [by video link]

CHENG, Professor Allen, Co-Chair, Australian Technical Advisory Group on Immunisation [by video link]

DE TOCA, Dr Lucas, First Assistant Secretary, Vaccine Taskforce, Department of Health

FREWEN, Lieutenant General John, Coordinator General, National COVID Vaccine Taskforce, Department of Health

KELLY, Professor Paul, Chief Medical Officer, Department of Health

McBRIDE, Mr Paul, Deputy Secretary, Strategic Evidence and Research, Department of Health

MULHALL, Mr David, First Assistant Secretary, Disability Group, National COVID Vaccine Taskforce, Department of Health

MURPHY, Dr Brendan, Secretary, Department of Health

SKERRITT, Adjunct Professor John, Deputy Secretary, Health Products Regulation, Department of Health

Committee met at 10:33

CHAIR ( Senator Gallagher ): I declare open this hearing of the Senate Select Committee on COVID-19. Today's public hearing will focus on vaccinations but may cover other matters under the terms of reference. Information on the procedural rules governing public hearings has been provided to all witnesses and is available from the secretariat. If a witness objects to answering a question, the witness should explain the basis for the objection in sufficient detail to allow the committee to determine whether to accept the objection. The committee will then decide whether to insist on an answer. Witnesses may request that answers be given confidentially.

We have representatives from the Department of Health, the National COVID Vaccine Taskforce, the Therapeutic Goods Administration and ATAGI. Is anyone wanting to make an opening statement or table any documents?

Dr Murphy : Lieutenant General Frewen will make an opening statement, as the main topic is on vaccines today.

CHAIR: The floor is yours, General.

Lt Gen. Frewen : Thank you for the opportunity to provide an update on the vaccine rollout to this committee. As you are aware, I was appointed on 8 June this year as Coordinator-General of the National COVID Vaccine Taskforce, which was week 16 of the vaccine rollout. As I stated during my appearance before this committee at that time, I have been appointed as we enter a new phase of the rollout to build on the progress in the rollout to date. In week 16 when I arrived, 5.2 million doses had been administered. Now in week 22, over 10.6 million doses have been administered.

Since my appointment I have undertaken an operational review of the vaccine program and developed a campaign plan that I am taking to national cabinet today. In the plan I have identified three key areas to focus on: improving coordination and efficiency of the plan, building public confidence and motivating people to get vaccinated, and a safe and efficient rollout of the vaccination plan. This plan has been developed in consultation with the states and territories, health and community sector organisations, business, industry, unions and other stakeholders. I intend to publicly release this plan after it has been through national cabinet.

I have had a particular focus on aged care. All residential aged-care facilities have had both their first and second dose visit. I have also deployed roving clinics in New South Wales and Victoria to vaccinate residents and workers in consultation with their health authorities. Overall program progress to date has seen three-quarters of over-70s receiving a first dose of COVID-19 vaccine and a third are now fully vaccinated. More than half of the over 50s have received at least a first dose and more than a third of the eligible population aged 16 years and above have now received at least a first dose.

Since I last appeared at this committee I have fast tracked the transition of general practice to administer Pfizer. This acceleration has seen around 1,250 practices administering Pfizer across Australia, including over 400 in New South Wales. I am boosting the program by accelerating community pharmacies to administer vaccines. I am immediately onboarding 64 pharmacies to address the current outbreak in New South Wales and these pharmacies will be administering AstraZeneca from next week. This means, from next week, I will have 251 pharmacies operating and delivering COVID vaccines, 64 in New South Wales alone. I continue to look for opportunities to fast track this program and ensure vaccine coverage across the nation. I am committed to administering the rollout with transparency. I have released data by state and territory and additional age breakdowns and I will be releasing more data, including on the aged-care and disability sector, shortly.

From now until the end of August I anticipate receiving one million doses of Pfizer per week. In conjunction with the additional points of vaccination and the willingness of the public to turn up for their jabs, I look forward to building further momentum in the weeks and months ahead. Thank you, Chair. I look forward to your questions.

CHAIR: Could we please have a copy of that, because there are questions that arise from that statement that I would like to ask. Is that able to be emailed? I have questions now but I would like a copy to work from.

Lt Gen. Frewen : I can give you this one.

CHAIR: I'll come back to your statement. Do you have any updates for me on the numbers of aged-care workers, disability residents and disability workers who have been vaccinated?

Lt Gen. Frewen : Sure. Is that workers and residents?

CHAIR: Yes, I would like workers and residents.

Lt Gen. Frewen : In aged care, we currently have 86.3 per cent of residents first dose and 82.3 per cent are fully vaccinated. In aged-care workers, we have 47.2 per cent first dose and 27.8 per cent fully vaccinated. In disability residents—

Senator SIEWERT: Could you say that one again?

Lt Gen. Frewen : Sure. Aged-care workers: first dose, 47.2 per cent; fully vaccinated, 27.8 per cent. In disability residents, we have: 57.7 per cent, first dose; 34.7 per cent, fully vaccinated. And in disability workers, we have 50.9 per cent first dose and 27.3 per cent fully vaccinated.

CHAIR: And that's up until—?

Lt Gen. Frewen : Yesterday.

CHAIR: Has that been published? Is that breakdown published in your updates on your vaccine numbers?

Lt Gen. Frewen : There is in the daily update slides—I'll just check exactly.

CHAIR: The question that comes out of that is they are all classified as 1a under the national vaccination plan. Why is it that 16 weeks after we were meant to have these populations vaccinated we are still at such low levels, particularly for the workforce? To have a third of the workforce vaccinated 16 weeks after the government's own deadline to get them done under 1a, what has gone wrong?

Lt Gen. Frewen : Earlier in the program, the focus was put onto aged-care residents, who were considered the most vulnerable. My understanding is decisions were made at the time to prioritise the residents over the workers because they were not only the most vulnerable but there was a concern about potential adverse effects of vaccination on workers at the same time. They didn't want to have workers unable to service the residents at that time. Since then we have been now focusing very specifically on the aged-care workers. You've heard that every aged-care facility has had a first dose and second dose visit now, and we have been running clinics back through to do top-up vaccinations, if you like. Now we're also doing workers as a priority, and the numbers on workers have been coming up. But now when our vaccinators visit the facilities, they will do workers and residents at the same time.

CHAIR: When you say decisions were taken, was that a national cabinet decision to prioritise residents over workers.

Dr Murphy : It was a programmatic decision that we made in the department.

CHAIR: Programmatic? Right.

Dr Murphy : That has been clearly borne out by the fact that, despite the big outbreak in New South Wales and several incursions into aged-care facilities, there have been six positive cases, with five out of the six vaccinated and all are well. We haven't seen the terrible consequences we saw in Victoria. There's no question that the major driver for vaccination was to protect those vulnerable for severe disease. It's a secondary effect to prevent transmission. We know, we've seen in Sydney, that fully vaccinated people can transmit, so it was a decision on two grounds. One is that the aged-care residents in the Australian context were the single most likely to get severe disease and unfortunately die, as we saw in Victoria. And the other advice was from the US, where they tried to do workers and residents at the same time, and doing mass vaccination of workers in one hit led to lots of absenteeism and significant challenges. So as we've discussed at this committee on many occasions, the complexity of doing aged-care residents was very significantly greater than the vaccination providers initially thought, so there was a programmatic decision that we had to get aged-care residents protected before winter, and we stand by that as an absolute priority. At the same time we've been doing workers the whole way through but the intense focus on the workers has happened now, as Lieutenant General Frewen has indicated.

CHAIR: My point is they were all 1a.

Dr Murphy : They were.

CHAIR: They were all meant to be done in that six-week time frame which you set yourself.

Dr Murphy : That was the original aim, but there are people in 1a who are continually being vaccinated yes. There are quarantine and border workers who are being done at the same time. So that was a programmatic decision that we think provided the best protection for the most vulnerable.

CHAIR: So you think that decision you made was the right one?

Dr Murphy : Absolutely. Protecting the aged care—

CHAIR: It was really an admission that you could have only ever done one. You could only do residents—

Dr Murphy : The two reasons were that we needed to get residents completely done before winter; we would need to give an intense focus on the residents. But the other reason that Lieutenant General Frewen and I have already said was the evidence that came from other countries was that trying to do all of the workers and the residents at the same time was causing significant disruption to facilities, as many of the staff were absent after the vaccination, and it was seen to be better to do it in a more compartmentalised way. So that was the decision taken at the time. We have protected the residents and we are very proud to have done that.

CHAIR: General Frewen, in your opening statement, you said you were focused on three key areas: improving coordination and efficiency, building public confidence and motivating people to get vaccinated, and safe and efficient rollout of the vaccination plan. Why are you having to do that 16 weeks in? Why wasn't this done at the beginning of the program?

Lt Gen. Frewen : Those things have been done up until now. I'm building on the work that has been done previously. This is the next phase of the vaccine rollout. I've indicated that when I came on board 5.2 million doses of vaccines had been delivered in 16 weeks. Now we are at a point where we are about to have greater amounts of vaccine coming in; we're about to open up many more distribution points. The plan I've developed is from here until the end of the vaccine program.

CHAIR: But, reading your opening statement, implicit in what you're saying is that coordination and efficiency, public confidence, motivating vaccination, and safety and efficiency are areas which you're concerned about.

Lt Gen. Frewen : I'm saying they're the areas I wish to focus on, having now taken control of the program. I'm not commenting on what was done before in those areas. I think all those things have been done previously.

CHAIR: But there are improvements in all of those, presumably. If you're focusing on it—you've reviewed it, and these are your key focus areas. They're areas where you've identified deficiencies and you need to make improvements.

Lt Gen. Frewen : I think there are areas where we can make enhancements. There'll be more enhancements than others in some of those areas. I'm here to accelerate, so I'll be looking at every option to accelerate.

CHAIR: What are the big problems you've identified in your review?

Lt Gen. Frewen : The review of the plan has led to this campaign plan. I've run activities with the states and territories, with the health sector and with others to refine the plan. The plan is an umbrella construct that will allow the states and territories to now work even more closely with us in partnership to achieve the rollout in their jurisdictions. Areas that I'm focusing on include seeking to bring more points of distribution. The rollout had been built on two key fundamental supply lines; one was down the primary health care network, the federal GPs and federal clinics, and the other was down the state clinics. That is what had, up until my arrival, delivered 5.2 million vaccines by that stage.

As we go through the year I'm now committed to bringing as many points of distribution into play as possible. You may have seen yesterday that we will now be bringing pharmacists into play. We're looking at all the options—mass vaccination clinics, pop-up clinics and pharmacies, as I've mentioned—because what I seek to have now, as we have that greater supply, is greater diversity of distribution points. In that we will have both greater resilience and greater flexibility, and as some things are working and others aren't we'll be able to move around in between them. Ultimately, by the latter months of the year I want to have maximum convenience in vaccination so that difficulty in getting vaccines is not a reason why some of those people who are perhaps more hesitant or perhaps getting around to getting vaccinated—so that that isn't an excuse.

The other thing is: I'm seeking to build relationships with the states and territories that will allow us to more dynamically reallocate vaccines between the federal and the state hubs. As we go further into the year I want to identify where there are efficiencies and perhaps inefficiencies, and be able to redistribute supply between those as quickly as I can. We're developing an assessment cell and developing specific relationships with each of the jurisdictions to achieve this.

The other key thing in the plan is: I'm developing a national response option, in military parlance—a commanders reserve of a workforce and, in time, when we have adequate supplies, vaccines as well—where we will be able to respond with a federal capability to assist states and jurisdictions to resolve a problem resulting from an outbreak, like we're seeing at the moment in New South Wales. Or, if a jurisdiction is just falling behind or if there is a particular locality that we've had an issue with, I've got an asset I can send to help those states and territories.

CHAIR: How much has lack of supply led to the problems with the rollout of the vaccine, after your review?

Lt Gen. Frewen : The vaccine rollout nationally has been built around the two vaccines, AstraZeneca and Pfizer. We've always known Pfizer was due to come later in the year. With AstraZeneca there were some challenges, clearly, around some of the guidance that was given around Pfizer that caused some slowdowns. But the program has been rolling on as well as it can with the supply we've got. Now, as we're getting to that period where we can get more supply, we will accelerate.

CHAIR: Okay, but that wasn't my question. My question was: how much has lack of supply led to problems with the rollout?

Lt Gen. Frewen : I think the rollout has been working with the supply available, which is what you do with any rollout.

CHAIR: So did supply shortages come up as part of your review—shortage of vaccine supply?

Lt Gen. Frewen : Having to prioritise between available vaccines is certainly a consideration, but, as with any logistic problem, you deal with what you have available.

CHAIR: Yes, and you didn't have enough.

Lt Gen. Frewen : Well, when do you ever have enough?

CHAIR: Hey?

Lt Gen. Frewen : When do you ever have enough? We are dealing with what we can get off global supply chains. This is a global pandemic with global demand for these vaccines. Vaccines have been procured. Vaccines are procured as they are produced. So we are dealing with vaccines as they come off supply chains.

CHAIR: Yes, but we only had two vaccines that were available to us, didn't we?

Lt Gen. Frewen : We have two currently.

CHAIR: Because of the number of deals that we had.

Lt Gen. Frewen : Yes, there are two vaccines available now and a third one that's scheduled to come on later in the year.

Dr Murphy : We had plenty of AstraZeneca for full population coverage. It was the unfortunate occurrence of the thrombotic syndrome and the ATAGI advice that limited the availability of AstraZeneca to the over-60s. That was the only factor that has made us supply constrained with Pfizer. We had plentiful supplies. We currently have plentiful supplies of AstraZeneca. That was a very unexpected event—the TTS—and I think the general has pivoted very strongly around that, and we have managed to work with Pfizer to get increasing doses. We're now delivering a million doses of Pfizer a week, and AstraZeneca is still holding up.

CHAIR: I know, but we had no redundancy.

Dr Murphy : We had other redundancy.

CHAIR: When those problems were identified, you didn't have any other to fall back on.

Dr Murphy : We have ordered Novavax. That was meant to come in quarter 2 this year. They have had production delays, but they are coming in quarter 3. We have Moderna coming in quarter 3, and we also have access to the COVAX facility, which has already supplied us with some Pfizer and can supply us with more. So we had a diverse, redundant supply but with a strong focus on local production.

CHAIR: Yes, but at the time we needed it we didn't have it. We didn't have enough Pfizer. When those decisions were made around AstraZeneca, we didn't have enough to compensate for that change in advice. That's correct, isn't it? We didn't have enough.

Dr Murphy : We have full population coverage of Pfizer, and we increased our Pfizer orders when those events occurred. Clearly in a global supply chain, like most other countries that don't produce a vaccine locally, we're dependent on those deliveries. So we have more than enough Pfizer coming. It is just coming progressively through the year.

CHAIR: Late, yes. But, when you ordered your first 10 million Pfizer and you were relying on AstraZeneca, what was the risk management—

Dr Murphy : At the time—

CHAIR: If I could just finish—sorry, Professor Murphy—what was the risk management exercise that was done supposing that AstraZeneca fell over or there was some issue there? When that happened, there wasn't enough Pfizer and you had to go and make other arrangements with Pfizer.

Dr Murphy : Remember that all of our vaccine purchases were on the advice of the Science and Industry Technical Advisory Group. At the time we ordered the 10 million strategic investment in Pfizer, we had double population coverage of two locally produced vaccines that were planned: the University of Queensland vaccine and the AstraZeneca vaccine. It has been, obviously, very unfortunate that the University of Queensland vaccine, which is an excellent vaccine, had an issue with the HIV. As soon as that one was discontinued, we increased our Pfizer order. Then, as soon as the AstraZeneca clotting issue occurred, we further increased our Pfizer order. But those decisions were made on the best expert medical advice at the time, and government has stuck with the advice that SITAG has provided. It was very unfortunate that having local production of vaccines has been the reason. Those country that have done really well in vaccinations, such as the UK and the US, have had local production of vaccines as their mainstay. That is the only way of getting really good early access, and we have adjusted our program according to the events that have happened over the time. But I repeat that our decisions were made on the best expert advice.

CHAIR: Okay, and you don't think in hindsight—

Senator DAVEY: Sorry, I just want to understand, because I've heard this line of questioning several times—that we didn't have a redundancy plan—what vaccinations are available and being used in the world today.

CHAIR: We can probably come to that when you get the call, Senator Davey. That would be more appropriate. In terms of where you sit now, Dr Murphy, you think all of those decisions were the right ones to make?

Dr Murphy : They were the decisions that were made by our expert panel, and I think they were appropriate for the circumstances at the time, remembering also that at the time when we made the strategic investment in Pfizer none of the vaccines had proven phase 3 clinical trial data and no mRNA vaccine had ever been used in humans. So our scientific and technical advisory group had a strong preference for protein subunit vaccines, which is why we did University of Queensland and Novavax—50,000-plus of each—and then a strategic purchase with local production of an adenovirus vaccine, AstraZeneca, which was the next most proven technology, and a strategic investment in the as yet unproven Pfizer on the 10 million they offered us, with an option to increase should it be successful and should we have issues with other vaccines. All of those options have been exercised.

CHAIR: But here we are today, with 13½ million people in lockdown and the major states in lockdown. We've got the lowest levels in the OECD in terms of our population vaccinated, and shortage of supply has contributed to that. So it has to go back to the original deal and the original advice to government or the decisions the government took.

Dr Murphy : The original advice to government was all accepted by government.

CHAIR: We know that.

Dr Murphy : Professor Kelly can talk to you about the delta strain, which is growing in countries even with much higher vaccination rates than ours. The delta strain is a very different issue. Professor Kelly can give you a description of that. So I'm not sure that you can say that our lockdowns are necessarily related to the vaccination rate.

CHAIR: Really?

Dr Murphy : What we can say is that the protection of the elderly and the vulnerable has been achieved, and that is the most important goal of the vaccination.

CHAIR: Every state and territory leader I have heard has said that the low vaccination rate is linked to the lockdowns and that lockdowns will continue while we have low levels of vaccination. You're saying that's not correct?

Dr Murphy : I'm saying that delta outbreaks have occurred in the UK and they're occurring in the US and Israel. Singapore has a higher vaccination rate and has locked down because of its delta outbreak. It's a complex picture. Certainly high vaccination is a factor in transmission, but I don't think you can directly attribute the lockdowns to our vaccination rate. If we had been where we planned to be—we're about two months behind our original plan because of the issues with AstraZeneca and international supply—it may well be that many of those states would have locked down anyway. Professor Kelly can address that issue.

Prof. Kelly : Thank you, Dr Murphy. As Dr Murphy has been saying, the vaccine rollout in the UK, for example, is extremely high. They are currently having more than 40,000 cases a day. They are not seeing the very severe end of the spectrum to a great extent, but there are deaths and there are ICU admissions. Many other countries around the world are starting to put in other measures, the standard public health measures that we have seen before, which they had before the vaccine rollout.

The reason, and this is what we've learnt all the way through this pandemic, is that things change. The major constraint at the moment is the delta variant. It is much more transmissible. Even in Sydney right now, with a very severe lockdown, the R effective, which is the number we look at about how transmissible the virus is in the population, is still over one. That means it is still likely to grow, and we need to think through all of the things we can do. They've put in very severe lockdowns. We're in very strong discussions with New South Wales at the moment about what we can do to assist further. One of those issues is the one that Lieutenant General Frewen has already mentioned around the vaccine rollout and expanding that vaccine rollout in pharmacies. This is the time to be nimble, as it has always been right through the last 18 months, to see what the data shows us, see what is actually happening on the ground and deal with those difficult moments. But we're not alone in that. The vaccine is part of the solution but it's not the only part of the solution.

CHAIR: I think Dr Murphy said that the vulnerable populations have been protected—

Prof. Kelly : They have.

CHAIR: We've got one-third of over-70s fully vaccinated.

Prof. Kelly : We have a very—

CHAIR: We have low levels in disability residential care. We've got low levels amongst the workers who work there. And now you're saying that the lockdowns aren't related to the low levels of vaccination, when I've heard every state and territory leader say they are directly linked to that fact and directly linked to the fact that vulnerable populations have not got the level of vaccination that they need for state premiers to feel comfortable about not having these hard lockdowns occur. You disagree with that or Dr Murphy does?

Prof. Kelly : Can I please use the data we have in front of us? I've compared the epidemiology of the current outbreak in Sydney with the one in Victoria last year pre vaccine. Dr Murphy has already mentioned the terrible scenes we saw in aged care last year in terms of residents dying, thousands of residents being infected and many of those needing to go to hospital. Terrible scenes. We don't want that repeated. What we have achieved—this is a major achievement that I think you should also think about. We have gone twice to every single aged-care residence in the country. We have offered the vaccine, and the vast majority of residents have taken that up.

CHAIR: As was committed to in 1a of the plan, to be done within six weeks.

Prof. Kelly : The result is that, whilst we have the issues in Sydney right now particularly affecting younger people, as we did in Victoria last year in terms of cases—it's mostly in that 20 to 40 age group—we're not seeing cases in older people. Why? Because that vaccine rollout of over 75 per cent of first doses in the over-70s is having an effect, and particularly the effect of the vaccine in the aged-care residents. We have seen both in New South Wales and in Victoria last month a large number of aged-care facilities that have been linked with the outbreak, either primary close contacts in staff or visitors. We've seen the occasional resident become infected. But so far none of them have been seriously ill. That is a major change from last year, and that's due to the vaccination program.

CHAIR: We will come back to this, because I should hand the call to Senator Davey or Senator Bragg. I don't know who's getting the call.

Senator DAVEY: I'll start today. As I alluded to before—I apologise for interrupting, Chair—I want to understand what different vaccinations are available. We do hear all the time that we should have had a redundancy program. My understanding, however, is that at this stage certainly in Australia Pfizer and AstraZeneca are the only two approved for use, with applications proceeding for Moderna and Novavax. What other vaccinations are available and being used around the world?

Prof. Kelly : Dr Skerritt can perhaps address it. That might be better.

Dr Skerritt : Thank you for your question. In addition to the two vaccines we've talked about this morning, there is regulatory approval but not a purchase or rollout of the Janssen vaccine, which is a single shot vaccine that is similar to the AstraZeneca vaccine. Given we have plentiful supplies of AstraZeneca, and the Johnson or Janssen—it's the same company, Johnson & Johnson and Janssen—vaccine has also been associated with TTS, thrombosis with thrombocytopenia syndrome, it wasn't felt necessary or appropriate to purchase additional quantities of that. It has regulatory approval because there is interest, especially in remote Pacific Island countries, where getting a team in to vaccinate once is hard enough. Getting the same team to come back to the same village on an island twice is almost impossible. There is that attraction, particularly for remote communities, of a single shot vaccine.

The other vaccines that we are currently evaluating are Moderna and Novavax. Dr Murphy has indicated that Novavax has had some scale-up manufacturing issues, and therefore we still do not have complete information on the manufacturing. With a vaccine it's not just the clinical trials, which I should add are quite promising with that vaccine, but making sure the product can be manufactured at scale and manufactured consistently. For that reason, Novavax has not been approved by any country globally. We do hope however, and we're on the phone to them almost daily, that we will receive a complete set of information in September, but we really are at the mercy of the company for when they've sorted out the manufacturing issues.

Moderna is a vaccine that's very similar to the Pfizer vaccine and has regulatory approval in a number of countries. We received an application for Moderna—I can give you the date; it was only a matter of a few weeks ago. I should put on record that, while we actively talk with companies and encourage them to put an application in to Australia, if, for example, they know they can't manufacture enough vaccine for the whole world, they adopt a strategy of, 'Maybe we'll just do the US first,' or, 'Maybe we'll just do it in Europe first,' because otherwise you create a demand that you can't commit to. We do have an application now from Moderna. We, again, are working with Moderna on a few manufacturing sites, so we are still waiting for data from them. Our advisory committee for vaccines, which is an external committee that looks at our evaluation work—they assess our homework, so to speak—is meeting on 30 July. Providing they're happy with it and providing we're happy with Moderna's responses, we would hope that there would be regulatory approval of that product in early August. Again, there are a lot of provisos there.

Just to finish up, there are a number of other vaccines that have been approved globally—about seven or eight—in jurisdictions ranging from Cuba through to China, India and Russia, as well as a few other weird and wonderful ones. We are interested in understanding those products because later on when borders open up it will be important to know about, for example, whether Chinese people who may have been vaccinated with a Chinese vaccine, or indeed Pacific Islanders who have been vaccinated with a particular Chinese vaccine, are considered to be fully vaccinated by Australian standards. We also are working in the region with funding from the department of foreign affairs. We have more than a passing interest in the other seven or eight vaccines that have been approved. There are reports of varying efficacy of those. In fact, there have been a number of concerns expressed recently with one of the Chinese vaccines because many Indonesian healthcare workers who were fully vaccinated with that vaccine sadly have passed away. Indonesia currently is a global hot spot for the COVID pandemic.

Senator DAVEY: I've heard about that in Indonesia. My understanding is that they have been relying a lot on the Chinese vaccine—is that correct?

Dr Skerritt : Correct. That's obviously a decision by the Indonesians. There are a number of countries. Peru has also been relying on it and, indeed, Thailand has been relying on it. Some of those countries are now contemplating a third shot with an alternative vaccine, such as Pfizer or AstraZeneca, to add to immunity. I don't want to badmouth a particular product, because we have not yet had access to the full clinical performance data, but it does appear that some of the other vaccines used globally are not as efficacious as the two that Australia have in use. Based on the clinical data we're looking at today, there are two we are currently evaluating for Australia.

Senator DAVEY: To be clear: at the time the ATAGI advice changed regarding AstraZeneca, we didn't have any other applications in for any other alternatives. So, when people are saying we should have had alternatives on the shelves ready to roll out, we didn't even have the applications in.

Dr Skerritt : At the time of the change to the ATAGI advice, or the couple of changes to the ATAGI advice, the only other product that was approved in Australia was Pfizer. The only other product we had a full application for was Johnson & Johnson or Janssen, and it has some of the same issues as AstraZeneca. As I mentioned earlier, our applications are incomplete for both Novavax and Moderna, so it's not as if I stood up a team working 24/7 on the Moderna or Novavax applications that we could approve it tomorrow or the week after. We're waiting on data from both companies.

Senator DAVEY: I have a couple of questions, which are probably for Major General Frewen, regarding the vaccination rollout. It's my understanding that we now have 251 pharmacies ready to go—64 in New South Wales. Are they mainly based in the regions or in urban centres?

Lt Gen. Frewen : The pharmacies that were brought on early in the program were based in regional and remote areas, where there wasn't GP coverage, but now we are focusing on a nationwide rollout. I am bringing pharmacies on as a priority in south-west Sydney right now. We'll have 48 of those starting on Monday. We've got another 118 across the nation currently, but, through to the end of this month, we will have more than 500 pharmacies brought on board. Through August, I hope to have just shy of 900 brought on board. By the end of September, we'll be getting up towards more than 3,000. Into October, we seek to have as many—there are around 4,000 pharmacies that we think are suitable online.

Senator DAVEY: And the delay in getting pharmacies on board—we've heard, through this committee, since the commencement of the vaccination rollout that community pharmacies were always part of the plan. Can you let us know why there was a delay in actually getting the pharmacies on board? Where was that delay?

Lt Gen. Frewen : My understanding is that a decision was made early to focus on GPs as the initial backbone, always with a plan for pharmacies. I think that has proved to be very effective to date. More than six million of the 10.6 million or 10.8 million doses that have been administered since have gone through the Commonwealth GP hubs, so I think that has been effective. But now the time is right for us to bring pharmacists into play.

Senator DAVEY: Do you have a breakdown of numbers for regional and remote Australia? I know we've been utilising the Royal Flying Doctors Service. According to their website, they've rolled out over 5,000 vaccinations in some of our most remote areas. Do you have a line of sight as to how many vaccinations are going out into the regional areas?

Lt Gen. Frewen : I will get my colleague Dr de Toca to speak to that.

Dr de Toca : Regional, rural and remote Australia have always been our main focus of the vaccine program, noting that for a range of reasons, so access to health care and other at-risk situations, it was a priority to ensure that the regions had equitable access to the vaccines, even though they have been less impacted by COVID so far—touch wood—than other parts of the country. At the moment we have parity of vaccine rates between metro areas and outside of metro areas and it's rapidly accelerating in remote and very remote areas through a combination of joint state, territory and Commonwealth primary care and the Royal Flying Doctors Service activity.

Aboriginal community controlled health services are also playing a major role in the remote aspects of the rollout. As part of the rollout to primary care, as General Frewen indicated, and the transition of primary care sites to also offer Pfizer in addition to AstraZeneca, we've recognised that it's important to index an extra loading on the regional, rural and remote sites through primary care to make sure that areas that are otherwise smaller in population but less dense, so harder to reach in a mass vaccination rollout, have early access to the vaccine. Of the current primary care sites administering AstraZeneca across the country, 1,289 are in the regions. Of those, 522 are already administering both AstraZeneca and Pfizer.

Senator DAVEY: Particularly with our Indigenous communities—and I note the fantastic work the Aboriginal medical health services have been doing in those communities—there have been reports of quite a significant vaccine hesitancy, perhaps more so amongst Indigenous communities. Are we starting to see that reversed? Are we getting good uptake in our Indigenous communities?

Dr de Toca : As you know, and you alluded to, every aspect of the COVID-19 response and vaccine rollout has been done in partnership with the Aboriginal health sector, primarily through the national Aboriginal advisory group on COVID-19. The Aboriginal and Torres Strait Islander stakeholders have also been quite vocal about focusing on how to drive uptake as opposed to potentially magnifying reports on hesitancy. We have seen pockets of hesitancy in some Aboriginal communities, as we have seen pockets of hesitancy in non-Indigenous communities, but we don't think there is a situation across communities of generalised differential willingness to take the vaccine.

We did see a significant proportion of the Aboriginal and Torres Strait Islander population accessing vaccine preferentially through primary care, majorly through Aboriginal community controlled health services. The changes to the recommendations for AstraZeneca, following the identification of the thrombocytopenia syndrome, meant that initially people under 50, and then under 60, preferred to access the Pfizer vaccine. The immense majority of the Aboriginal and Torres Strait Islander population is under 60, so this meant, for a period, Aboriginal and Torres Strait Islander people weren't able to access the preferred vaccine for their age group that was relevant to the majority of the population through their preferred channel, which was primary care and Aboriginal community controlled health services. That is why we have prioritised access to Pfizer through Aboriginal community controlled health services really early—in fact, the first primary care sites that accessed Pfizer all up, adding general practices, Commonwealth vaccine clinics and ACCHOs, were Aboriginal health services. We currently have 84 Aboriginal community controlled health services administering Pfizer across urban, regional, rural and remote areas, and we are seeing an uptick in vaccination rates for Aboriginal and Torres Strait Islander people. Anecdotally, a vaccination blitz that was conducted as a joint approach between the local Aboriginal health service, the Royal Flying Doctors and WA Health in their Ngaanyatjarra lands last week saw 500 vaccinations administered in those communities in one day. I think one or two people in the entire community declined to receive the vaccine, which is a much better uptake than average.

CHAIR: Thank you, Senator Davey. I'll now go to Senator Keneally.

Senator KENEALLY: Thank you to the officials for being here, I appreciate it. Professor Murphy, we've just heard from the New South Wales Premier that there are 136 new cases in New South Wales today—53 people were infectious while they were in the community and there has been another death. Would you characterise this rapidly developing situation as a national emergency?

Dr Murphy : I'll get Professor Kelly to answer that, as the Chief Medical Officer. I think it is a very serious situation, but Professor Kelly is right across it.

Prof. Kelly : It's a very serious situation, particularly in south-west Sydney, but not only in south-west Sydney. There are several elements to that. As we know, south-west Sydney is a very diverse community. The people who work in that community are, indeed, essential workers for the entire Sydney basin and beyond. People that work in distribution centres, people that work in construction, people that work in aged care, et cetera, are all in that very diverse and rich community.

The challenge has been, and it continues to be for New South Wales, that the normal things we've been used to doing in relation to this virus, in previous iterations of the virus, before we had this particular delta variant of concern, are proving to be not as effective as they have been in the past. We're not alone in this experience; the delta variant has spread to well over 100 countries all around the world and every country that has this variant is experiencing the same thing. I know that the NSW Health officials are working extremely hard. They're very engaged with the community. It is an enormous challenge. Even with the lockdowns that we've seen so far—and they are very strict—it is proving difficult to get this particular outbreak under control.

Senator KENEALLY: The New South Wales Premier, Gladys Berejiklian, has described this situation in New South Wales, and particularly in south-western Sydney, as a national emergency. She has now advised residents in the Cumberland and Blacktown LGAs that they are unable to leave their LGA unless they are an essential worker, bringing to five the total LGAs that are in this extreme lockdown situation. Professor Kelly, you were just discussing the challenge, I should say, and the importance of the number of essential workers who live in that portion of Sydney. The Chief Medical Officer in New South Wales, Dr Chant, is now calling for the vaccine to be prioritised for essential workers who are under 40. Is that something that has been raised with the Commonwealth?

Prof. Kelly : Yes, it has Senator.

Senator KENEALLY: What is the Commonwealth's response?

Prof. Kelly : I speak to Dr Chant at least three times a day, and we've been in close contact with her again twice this morning and last night. The night before, Professor Murphy and I had a long conversation with her and relayed her concerns around these matters to others, and those conversations are ongoing.

Prof. Kelly : 'To others'? What does that mean?

Dr Murphy : General Frewen is in discussion with New South Wales about that issue. General Frewen is in discussion with NSW Health authorities about essential worker vaccinations.

Senator KENEALLY: Is there anything else you can enlighten us on here, General Frewen?

Lt Gen. Frewen : No, I'm in close consultation with the New South Wales authorities. We're looking at a whole range of options about how we can support them in relation to vaccine rollout specifically.

Dr Murphy : It may be worth talking---

Senator KENEALLY: From your view, General Frewen, is there any refocusing on specific priority groups that you're starting to consider as a result of the national emergency that's occurring in New South Wales?

Lt Gen. Frewen : Of course, vaccines are only one part of the response to an outbreak like this. Lockdown, testing, tracing, isolation, social distancing, masks—all of that is really critical in this sort of situation. Vaccines underpin a national health response. Right now our task force is working specifically with NSW Health authorities on how vaccination response can be focused. Initially we've been working on the three LGAs and the surrounding areas to the LGAs. We're also working with jurisdictions elsewhere: Victoria, South Australia. Wherever these sort of things happen, we have a look at exactly what can go on.

Right now, we are working with New South Wales on a number of priority areas: over-70s, of course, and aged care, and we've talked about some of the response to aged care already, with the roving clinics we have doing aged care. We're doing a lot of work to encourage over-70s to continue to get vaccinated as the most vulnerable community group. We're working with industry right now on food distribution hubs and workers in those areas. We're also working on other sectors such as the construction industry right now. We're engaged, we're working through it. We're working to open up as many avenues as possible for vaccination. We're focused on what the Commonwealth hubs can do, as well as GPs and pharmacists. As I've said, we'll have 48 pharmacies open on Monday in those LGAs. We're also working with the states on how we can provide support to their clinics or whether, from their resources, we can provide support to our GPs as well.

Senator KENEALLY: Thank you for that. The Premier, Gladys Berejiklian, has said today in her media conference that she's calling on the Commonwealth to 'refocus the national strategy' for the vaccine rollout. She says that one of her priorities is to have more first doses of Pfizer given the younger age profile of South-Western Sydney. Is that something that has been raised with you?

Lt Gen. Frewen : It has been raised this morning, and we're having discussions about that. Dosage intervals are one of the many tools in a response. I'll leave my Health colleagues to speak about the benefits and impacts of that. There are decisions to be made about whether it's better to have people fully vaccinated or whether it's better to have, perhaps, people with single-dose vaccination in relation to transmissibility concerns. But, yes, we're looking at that at the moment and we're looking at how, whatever New South Wales authorities decide around this, we can support them.

Prof. Kelly : I might just add that one dose is better than zero and two doses are better than one, but, in an outbreak situation like this, you need to balance all of those things, as the lieutenant general has said, about which would be the best way of protecting the vulnerable and decreasing transmission, recognising that the vaccines themselves would not immediately do either of those things. So that is why we need both the public health responses, which are a state responsibility, and the vaccines as we can assist.

On priority populations, just in the last week I've had—and Lieutenant General Frewen has his own list—a list of many, many different essential workers. They are all essential. They are all a priority, but we have to prioritise within that prioritisation. I've asked today specifically for New South Wales Health to give us very detailed information, particularly about those that are still infectious in the community, because that's what's driving the epidemic in South-Western Sydney. I suspect and believe that many of those are essential workers. We need to know what those essential workers are and the specifics of their situation and make an appropriate policy response on the basis of that information.

Lt Gen. Frewen : As the lead of the national vaccine rollout, I think it is really important that we continue at speed with the vaccine rollout broadly across the nation. Yes, there is a particular concern right now in those LGAs in Sydney, but, as you would appreciate, it can spill out of those areas very quickly.

Senator KENEALLY: Yes.

Lt Gen. Frewen : Outbreaks are already occurring in other parts of the country. So it's always a balance, and I'm very keen that we manage national vaccine rollout as fast as we can while providing whatever focused support we can to the specific outbreaks.

Senator KENEALLY: Thank you, because I did want to get to that before my allotted time here expires. First, the Premier has said it's clear that we are not going to be close to zero by next Friday, foreshadowing that the lockdown that we are currently experiencing here in Sydney is going to continue beyond next week. What is a realistic time frame here for when some of these decisions will be made—the decisions about essential workers, under 40 and the decisions about more first doses of Pfizer given the younger age profile?

Lt Gen. Frewen : Well, we're making decisions every day. As I said, on some of those workforces I just mentioned, we made decisions yesterday about getting to the food distribution hubs as a priority and about getting to workers as a priority. This is an ongoing dialogue. The situation changes by the hour in some cases.

Dr Murphy : I'd just like to reiterate that of course General Frewen is absolutely correct. We need to take this particular issue in South-Western Sydney and beyond to a national sphere. We have lockdowns, as has been mentioned, in Melbourne and the whole of Victoria and in South Australia. They were both seeded from this outbreak. That can happen at any time in other states. Whatever decisions we make, of course, flow on to opportunity costs in other areas. That has to be absolutely and very carefully considered.

Senator KENEALLY: I was going to ask about the impact of a redirection of vaccines to New South Wales. Would that have an impact on other states?

Lt Gen. Frewen : If vaccines were to be redirected from other states, absolutely. I mentioned earlier that we're rolling out to GPs as a priority. We're rolling out to additional GPs with Pfizer, as a priority, and to additional pharmacies, focused on AZ right now. The strategy we're taking in New South Wales: I've got the 48 that are going into those LGAs—they've already gone in—starting early next week. We have then got a ring of additional things going in around the LGAs and then around remote regional areas in New South Wales. We're taking an approach so that if, God forbid, things start to spread out from those LGAs, we've also put in place things that will help contribute to containing that as well. It's a layered strategy, and we're constantly reviewing our approach and priorities.

Senator KENEALLY: Thank you for your answers so far. Something that some of my colleagues particularly in Western and South Western Sydney have heard from GPs is that they're not entirely sure how supply is being calculated for individual practices—that they just receive what they receive. I'm trying to understand (1) the process for allocating supply to GPs. But, also, the Prime Minister did say that he would ramp up supply to South Western Sydney. Do you have supply volume figures by Primary Health Network in Greater Sydney that could be supplied to the committee?

Lt Gen. Frewen : I'll reiterate the broad principles and then I'll let Dr de Toca speak to the detail. We are allocating vaccine supply on a per capita basis across the nation. Each of the states and territories are being given a proportionate allocation. With Pfizer, we have made a decision that all available Pfizer will be distributed and provided to the states and territories upfront, as was agreed at national cabinet—and Dr de Toca can talk to the specific allocations that you were seeking. But right now we have AstraZeneca available, because supply is exceeding demand with AstraZeneca, although demand for AstraZeneca is rising by the day. At the moment, we don't have surplus Pfizer, because the decision was to allocate all Pfizer out. The jurisdictions are responsible for managing their allocations of Pfizer, with their particular priorities. We have been pushing Pfizer down through the GP networks, but, again, in each of the states and territories, you have two main distribution networks: the Primary Health Care Networks and the state and territory networks.

Dr de Toca : Allocations for general practices are advised to the practices well in advance. For AstraZeneca we commenced with a three-tier allocation structure based on available supply, but subsequently, as the program rolled in, we continually increased it up until about a month ago when all practices were brought into either a 400-a-week allocation or 600-a-week allocation, noting that that is the maximum allocation that they are able to order. Practices can make a choice to order less than that. With the varying supply of AstraZeneca, many practices have ordered less than what their allocated total is. However, we have been responding very proactively to any request for additional vaccines that we have been receiving. There have been 139 requests from general practices in the Greater Sydney area for additional AstraZeneca supplies that have all been honoured and have resulted in an additional 35,700 doses of AstraZeneca being delivered to those GPs.

With Pfizer, we commenced with a two-tier allocation, in which practices receive a total of either 150 doses a week or 300 doses a week, although they commence with half of those and they scale up as they stabilise in first and second doses. What we have also done is reach out to GPs that are doing Pfizer in Greater Sydney. Seventy of them requested an update to their allocation, from 150 to 300, which we have put in place as part of the focus and efforts that General Frewen referred to.

CHAIR: Senator Keneally, I will have to hand the call on. Before I go to Senator Siewert, in light of the outbreaks we are seeing across the country has the government tried to purchase more Pfizer or bring forward more of the purchase over and above the announcements that were made a couple of weeks ago?

Dr Murphy : Absolutely. We are working almost every day with Pfizer, and, as you are aware, we have increased our supply now to a million doses a week. Minister Hunt has been working with Pfizer. The Prime Minister and Minister Hunt have written to the global CEO. The Prime Minister has spoken to the global CEO; those discussions are commercial-in-confidence. I can say that we have been working with Pfizer at every opportunity to try and see if we can bring forward doses. They have a very clear national prioritisation that they plan. They've got the whole world to supply, and they have never failed to deliver what they've offered. We are now slowly increasing our supply. So we continue to work with Pfizer.

CHAIR: But is it about buying more or bringing forward?

Dr Murphy : We don't need to buy any more to complete our vaccination of first doses or fully vaccinated—

CHAIR: But, if we had another deal to buy more, would it bring some here now?

Dr Murphy : No. Pfizer have never said an additional purchase would enable that. They allocate out months ahead.

CHAIR: Okay.

Senator SIEWERT: If we can't get more Pfizer, can we accelerate the time line to get more Moderna? We've already heard that Novavax is having problems with supply. What's the time line for bringing forward access to the Moderna vaccines that the government has also contracted for?

Dr Murphy : Moderna are currently committed to provide some doses in September. We will continue to work with them, to explore if their production volumes increase and whether they can give us more earlier. We're working with all the companies we have contracts with, but at the moment their commitment is only to give us some doses in September.

Senator SIEWERT: How many doses in September?

Dr Murphy : At the moment they are offering about a million doses in September. We'll get more clarity from Moderna as we get closer to the time. Most of these companies do a monthly projection globally. We will continue to work with them to see if we can get any more. At the moment they are only committing to a million doses in September. These companies have been very reliable. They don't want to overcommit, but, if they can, they will do what they can to bring forward doses.

Senator SIEWERT: Do you have any notification from Novavax of when they expect to be able to deliver?

Dr Murphy : Novavax are currently promising to deliver some doses in quarter 4. It will be some millions of doses in quarter 4. But, because we don't have full registration yet and we don't have a clear production time line, our current plan is not dependent on having Novavax for our primary vaccination course this year, but they are still committing that they will give us some doses in the fourth quarter. If they come, that will be valuable and could help accelerate. But our plan is not dependent on having Novavax this year.

Senator SIEWERT: My next lot of questions are to the TGA and to ATAGI. On today's announcement around approval for Pfizer for children between the ages of 12 and 15: I would like to understand the process from here. Does that have to go to ATAGI as well or is that now—

Dr Skerritt : The two roles of the TGA and ATAGI are different. The TGA's approval means that the balance of benefits to risks is highly positive. We've made the decision, based on all the evidence submitted to us, that the vaccine is safe and effective for children over 12 years old. As per any vaccine, the decisions on which populations it's most appropriate to prioritise are made by ATAGI; this is not just with COVID vaccines but with other vaccines. As we heard earlier there are a range of approaches used globally, from the US vaccinating pretty much a wide range of high-school kids through to the UK saying, 'Let's give it to kids who might have particular disabilities or might be immunocompromised, but let's not open it up yet to every high-school kid over 12.' ATAGI's job here is to work out which populations, within the broad group over 12 that we as the TGA have determined, the vaccine is safe and effective for.

Senator SIEWERT: Can I go to ATAGI, please. What's the time line for you considering that, and which populations do you consider should be prioritised?

Dr Blyth : Thank you for your question. ATAGI is considering this advice at the moment. Clearly that's contingent on the TGA registration; that has now occurred. We will be considering this over the next short period of time to get clear recommendations out. I think we need to consider those recommendations, given the fact we still have limited Pfizer supplies as well. We will need to give clinical recommendations on, if there are populations of adolescents that are recommended, which populations and, importantly, whether there are specific higher-risk children that should be first in line as opposed to other children.

Senator SIEWERT: You said you're considering that. What time line do you expect, and have you already considered those populations you just talked about in terms of those most vulnerable? Or have you already considered those groups that you think we should be targeting first?

Dr Blyth : This is under consideration at the moment. We are likely to be [inaudible] next week. Importantly we're waiting on further information before we can land on our final position. I don't expect significant delays here, but I think this committee would be respectful of the fact this is an important decision to make—one that we will need to consider for the broad ATAGI.

Senator SIEWERT: You said you're waiting for additional information. What sort of information are you waiting for?

Dr Blyth : There are a number of important pieces of information here in understanding what the registration looks like—that will be reviewed in detail, now that the TGA has made that; we have already spoken to a number of other countries that are looking at rolling out programs in adolescents, to understand their thinking—and, importantly, understanding our local epidemiology, particularly: are there groups of children at particular risk who should be prioritised ahead of a broader program?

Senator SIEWERT: Can I go very quickly to a paper. I'm not sure whether this is for ATAGI or the TGA, so I'll ask you both. There's a paper from Germany—admittedly, it hasn't been peer reviewed—that looks at the connection between TTS and the way injections are administered. It's missing, for example [inaudible] going into the blood supply. Have you looked at that paper, and is it [inaudible]

Dr Skerritt : We have looked at that. I'm aware of the paper you refer to. As you indicate, it has not yet been published. One of the challenges of the COVID pandemic—we saw this with a lot of papers on hydroxychloroquine that initially looked very promising, but, when the data was reviewed and the larger studies were done, the data, sadly, didn't show overarching benefit. So I am cautious about their conclusions. Their conclusions have implications for adenovirus vector vaccines writ large, in that they're proposing that differences in the processing and differences in the movement of the product into the nucleus of a cell could be a mechanism of action of TTS. While, clearly, there seems to be an immune component to the reaction to TTS, I think it's fair to say there are a range of hypotheses about how TTS arises. That German group has one view, but I wouldn't say it is universally accepted as a view. It'll be interesting to see how that paper is refereed and what commentary there will be after, we assume, it is published.

Dr Murphy : Professor Cheng or Professor Blyth might want to comment further on that.

Prof. Cheng : I can probably answer that. I think the study you're referring to is a mouse study and obviously is an experimental study you can't study that in humans to the same degree obviously. But there are some key differences other than mice being different to humans. The side effect that was seen occurred very early in mice and that's very different to how we see it in humans, where it tends to occur at least after four days and usually many weeks after that. So the generalised ability of those experimental findings in mice to humans isn't entirely clear. They do have theories about why that might be different and so on, but it isn't as clear-cut that this is the same syndrome in mice that we see in humans.

Senator SIEWERT: The Prime Minister has been constantly asking ATAGI to reconsider its advice. Has that, in fact, been happening, and what's your response to that?

Prof. Cheng : We were asked to continually review the evidence about TTS and other adverse events related to AstraZeneca. ATAGI has been meeting every week and has been putting out a statement every week updating advice. Most recently we met on Wednesday, and a statement from that is expected shortly.

Senator SIEWERT: Can you advise the committee as to what your most recent advice is going to be or is?

Prof. Cheng : It basically will reiterate the previous advice. There is no change in what the advice is, but there are some figures that the TGA have updated us on. That doesn't really change the balance of risks and benefits in the risk of TTS. Obviously the benefit of vaccination, particularly in Sydney at the moment, is somewhat in a state of flux. We provided advice on 13 July about the use of AstraZeneca in the context of outbreak situations.

Senator SIEWERT: I would like to go to looking at the issue around aged care and aged-care workers. The Prime Minister announced mandating vaccinations for aged-care workers. Under what state, territory and Commonwealth powers is the Commonwealth going to enforce that?

Dr Murphy : The agreement at national cabinet was that the states and territories would mandate the vaccination under their public health orders, which is the way that we did it for influenza vaccination last year. The agreement was also that the Commonwealth, through our aged-care system, would be monitoring the vaccination rates, reporting on those vaccination rates and would be responsible for ensuring compliance. But because it is a public health issue, it was seen that the best way to do it was through state and territory public health orders, and all states and territories have agreed to progress that. It would be possible to use Commonwealth powers but they might need legislative change or the use of the Biosecurity Act and it was seen to be better to use public health orders.

Senator SIEWERT: My understanding is that that does not include home-care workers in aged care?

Dr Murphy : Not at this point. It was felt that the mandatory approach was AHPPC advice and the advice of the aged-are advisory committee which guides AHPPC. Their advice was that the higher priority was residential aged-care workers. Professor Kelly can talk about that. But they are continually reviewing to see whether that could be expanded, for example, to residential disability or other workers.

Senator SIEWERT: Given the highly infectious nature of the delta variant, how urgently is this being considered given that these workers, both aged care and disability, are going into people's homes? That is happening right now all over Australia, but particularly also in New South Wales

Prof. Kelly : So I'll just add one thing and then ask Lieutenant General Frewen to talk about what he's been doing very actively in this space in increasing the take-up. But you're quite right, Senator Siewert; this is a new variant. It does have different challenges, as I've spoken to. But we continue to be committed to protect those most vulnerable people directly and the workers that every day have to go and assist them with vaccination. Professor Murphy and Lieutenant General Frewen have spoken to the challenges in relation to that.

Lt Gen. Frewen : Aged-care workers is one of our top priorities inside the task force right now, and we have developed a very specific plan to ensure that we get all aged-care workers fully vaccinated by mid-September. We are—

Senator SIEWERT: I asked about home-care workers. I heard what you said about residential care workers. I'm talking about home-care workers.

Dr Murphy : Home-care workers are definitely in our priority group and they have access to all of the vaccination services that General Frewen has initiated, with the exception of in-reach obviously. You can't do in-reach into the home-care environment. We are certainly making vaccination available to home-care workers of any age. But the priority, again, has been residential aged care because that is by far the biggest risk transmission environment. You will recall even in the Victorian second wave last year, there were almost no cases in home care. It's the residential care environment that's the highest risk, which is why national cabinet, on the advice of AHPPC, decided to prioritise residential aged-care workers. There is still an ongoing focus on the rest of the disability care workforce and the home-care workforce, but the priority is the residential aged-care workforce.

Senator BRAGG: Thank you very much for the work that all the officials are doing. These questions are to the department. I'm interested in picking up on some of the comments made about the delta variant. I think there was a reference made before that this has not been successfully brought to heel by any government yet. Can you talk a little bit about some of the lessons that we are picking up in real time about how we can manage this delta variant, please?

Dr Murphy : I might answer those. Look, it's the same virus. It's a respiratory virus. We know how it spreads. It spreads as people move around. It spreads when people cough, sneeze, breathe. It mainly goes via the air. So all of those things are the same for this particular variant compared with other diseases, for example. All of the things we've learned along the way about how we deal with respiratory viruses are still valid and we're still doing them. The difficulty with this particular variant is that it has definitely become more transmissible—that is, it can move more quickly between people. It appears that people with this virus, particularly and specifically, if they're not vaccinated, carry more virus, so the spread of the virus is increased through that mechanism. They appear to become infectious earlier than previous variants, and that infectiousness starts earlier, so even before they develop symptoms. We have known that all the way along but it seems to be more prominent with this delta virus. So all of those things mean getting on to all the things we've been doing since the beginning—the contact tracing, the testing, the isolation—as quickly as possible, as is occurring right now in South Australia and which has occurred over the last week or more in Victoria. Indeed early on in New South Wales they were also doing that, getting on to people very quickly, making sure as much as possible—and hopefully 100 per cent of the time—that people who develop infectiousness, become positive to the virus, are already in quarantine themselves. What we're seeing there is that—and this is happening in south-west Sydney right now in particular—in households almost 100 per cent of the household become infected themselves. So that's very much different to previous iterations of the virus. The two key figures that we need to watch are: are the cases linked? Do we know about all those chains of transmission or are there so-called mystery traces in the community? And amongst those in particular, but also the ones where we know of linkages, were they in isolation or in quarantine before they become infectious? Those are the key metrics. We will expect that the actual numbers themselves will grow, but we need to see those two figures going down. That shows control. Unfortunately at the moment in New South Wales that is not the case for either of those particular metrics.

Senator BRAGG: Do you have any updated numbers on case numbers and deaths from offshore on the delta variant? Is that information that you have?

Prof. Kelly : We're watching other countries that are experiencing similar waves. I would say that there are many countries in the world that are now grappling with delta virus. It's become essentially the virus for most of the world now. It's the variant that is more transmissible, which means that it has an advantage over previous variants of the virus in terms of it spreading from person to person, and they're the outbreaks we're seeing. We can watch those. We're particularly and specifically interested in those that have high vaccination rates already. Israel are undergoing a delta outbreak at the moment. They have gone back to some of their more blunt public health arrangements, including lockdowns.

The UK have, quite publicly and famously, this week moved away from lockdown measures and so forth, despite the fact that they're having tens of thousands of cases per day. It's mostly in younger people, mostly in the unvaccinated, and whilst there are some severe cases in those age groups it's way, way less than their previous waves. If you look at their wave of cases that's starting to look very similar to the two previous waves in the UK in terms of numbers. It's mostly in younger people. But their hospitalisations, ICU rates and deaths have not risen as they did last year and earlier this year. That's a vaccine effect.

In the United States they're seeing a similar increase. That's particularly related to undervaccinated areas. In the US that's very much related to the urban poor and to other places where there is not as good access to vaccination or a large degree of hesitancy.

We're learning from all of those examples and we need to make sure that we're addressing those in our vaccine rollout. Lieutenant General Frewen has already mentioned some of those strategies.

Dr Murphy : It is worth mentioning that the UK is having about 50 deaths a day and the US about 400 deaths a day, despite high vaccination rates, which is really good evidence of this delta variant.

Senator BRAGG: Are they dying from delta?

Dr Murphy : Delta is the predominant strain in those countries, yes.

Senator WATT: They're likely unvaccinated people aren't they?

Dr Murphy : In the main—that's the data we believe—yes.

Prof. Kelly : In our local data here tragically we've had some deaths in Sydney in recent times. I don't know the details of the one today but all the previous deaths, from age 50 up to high 90s, have been in unvaccinated individuals.

Senator BRAGG: Given that vaccination is the key for getting out of this, what is your current advice to Australians eligible to get a vaccine?

Dr Murphy : I think our advice would be very much consistent: please turn up and get a vaccine, particularly if you are over 60. We have plenty of AstraZeneca and plenty of points of presence. You can get an appointment very quickly. General Frewen is rolling out more points of presence. Go and get that vaccine. The risk-benefit ratio of vaccination for AstraZeneca in people aged 60 and over is way in favour of vaccination. To those under 60 who want to get access to AstraZeneca, it is available. You need to have informed consent. General Frewen can give the data on this, but a significant number of younger Australians have taken it up. To those who are currently eligible for Pfizer in the priority groups and in the over-40s groups, please book in for your vaccination.

Lt Gen. Frewen : Since AstraZeneca was offered to the under-40s with informed consent on 28 June, 43,132 young Australians have chosen to take AstraZeneca.

Prof. Kelly : Could I just reiterate what Dr Murphy said. As the Chief Medical Officer, this is not the time to hesitate. Anyone who's eligible for vaccination should be looking to get that first vaccination if they haven't already done so. I say that particularly to the people of Sydney but also throughout the country. Anyone who has had a first dose of AstraZeneca, at whatever age, should go and book in for their second dose, or they should have that booking already. Do not cancel it. If you have concerns, talk to your GP or your other health provider. We know that two doses of AstraZeneca, including against this delta strain, are very effective at preventing severe illness. That is what we're really homing in on. Our ATAGI colleagues may want to comment on this, but they provided extra and changed advice in relation to the dosage interval for AstraZeneca in the situation of an outbreak—specifically in Sydney, but that would also be the same in Melbourne and Adelaide now—which is to have the second dose earlier, at four to eight weeks after the first dose. This is not the time to hesitate on a second dose of AstraZeneca.

CHAIR: Is that all, Senator Bragg?

Senator BRAGG : Finally, just for the record, is it ultimately for the consumer under the age of 60 to decide whether they want to have AstraZeneca?

Dr Murphy : Absolutely. ATAGI has been very clear about this. The vaccine is registered for all people over 18. They have said it's preferred on the risk-benefit ratio to prioritise the under-60s for Pfizer, but it is absolutely open to any person over 18 to have AstraZeneca, provided they understand the very small risk of clots versus the benefits of vaccination. That risk-benefit equation, as ATAGI has said on many occasions, depends on the epidemiological circumstances. Certainly, in Sydney now, that risk-benefit equation has changed as ATAGI has indicated.

Lt Gen. Frewen : AstraZeneca is available right now across the nation. I went onto the eligibility checker yesterday and I was able to get a next-day booking for AstraZeneca here in the ACT. I am already fully vaccinated with AstraZeneca. Right now in New South Wales, AstraZeneca is available. We are providing more distribution nodes for AstraZeneca, and people should make that informed choice.

CHAIR: In light of some of the evidence we had this morning, Professor Murphy, from where I sit, we've got a national emergency in New South Wales that started with an outbreak from the quarantine system. We have five council areas in New South Wales in a severe lockdown. We have some 14 million Australians living in lockdown today. We have the slowest vaccine rollout in the developed world, with only 12 per cent of the population vaccinated. We don't have enough of the preferred vaccines for our population and we don't have targets for the vaccination program. Seventy per cent of people over 70 are not fully vaccinated. We have a leaky hotel quarantine system that's not fit for purpose. We have caps on international travel, and those caps have halved, yet we have 36,000 Australians stranded overseas who can't get home. We've got kids missing school, families missing funerals and weddings, and people struggling to pay their bills. Meanwhile, the rest of the world is opening up. The Treasurer is also now pointing to negative economic growth for next quarter. Surely, at the end of that, the federal government's management of this pandemic is failing from your point of view, isn't it? Do you join with the Prime Minister in apologising to the Australian people for the suffering that they're currently going through?

Dr Murphy : For a start, the outbreak in Sydney was not due to a failure of quarantine; it was due to transport of aircrew and a public health failing in transport. There was no leakage from hotel—

CHAIR: As part of the quarantine program—driving to quarantine.

Dr Murphy : The same would have happened whatever facility was being used for quarantine, so it was not a quarantine failure. Certainly I join with the Prime Minister in saying that we are sorry that the vaccine program has been delayed by the unexpected events that have happened, but I point to the successes in our vaccine rollout and I refute the general contention of your statement.

CHAIR: Which parts do you refute?

Dr Murphy : I think our management of the pandemic would be regarded internationally as one of the best in the world. We have had some issues with the pace of our vaccine rollout, but I would much prefer to be in Australia rather than any other country in the First World. Look at the number of deaths in England and elsewhere in the UK. We have largely lived a normal life for most of this pandemic. Certainly this Delta variant is stretching us now. We have been, in most of the country, back to normal, when parts of Europe and the UK have been locked down for several months. Our management of the pandemic has been very strong and based on the best medical advice.

CHAIR: I would separate the management of the initial response to the pandemic from the vaccine rollout. I think we've had a good response to the pandemic in its first phase, and we're in the place we're in today because the vaccine rollout hasn't done what it needed to do and the quarantine system is not fit for purpose. That's what's led us to where we are today.

Dr Murphy : I would refute the contention that the quarantine system is not fit for purpose. As to the vaccine rollout, we have had some challenges that were beyond our control, but it is going very strongly now—a million doses a week. General Frewen can tell you we've had another record day in the last 24 hours.

CHAIR: People in New South Wales might feel a bit differently today. We might break there.

Proceedings suspended from 12:06 to 12:20

CHAIR: I'm going to go to Senator Watt; I know he has questions for ATAGI. I understand Senator Patrick has some questions for ATAGI, so my intention is to go to Senator Watt and Senator Patrick. I also have been advised that General Frewen and Professor Kelly must leave at 1.30 to attend to matters prior to national cabinet. As chair, I am happy to facilitate that, but it might just mean we'll have to shorten some questions, so I want to give people forewarning of that. I will try to be as fair as I can and prioritise non-government senators in light of the shortened hearing, as government senators of course have other avenues to elicit information. Senator Watt, you have the call.

Senator WATT: Most of my questions are for ATAGI, but I do have a couple for the TGA and others as well. I'll start with the TGA. Regarding the vaccine weekly safety report from yesterday, that sadly revealed more blood clot cases. Are the events set out in yesterday's report consistent with your previous understanding of the risk factors for adverse events such as age and gender?

Dr Skerritt : That's the TGA weekly safety report that was released. It was consistent. We've been comparatively fortunate—even though every death of course is very sad—that our rate of death with adverse events and TTS syndrome has been so much lower, for example, than in the UK. The UK is averaging 17 or 18 per cent. Even with the most sad two cases reported yesterday, we are still down at five or six per cent. With small numbers of cases, two cases can change a percentage very quickly, but the pattern of adverse events is consistent with the past. It's quite clear that the severity of the adverse events is greater in younger people, so not only is the number of TTS cases relatively higher—not by an astronomical margin; it might be 50 to 80 per cent higher, depending on which age cohort, say, under 50 or under 60 versus over 50 or over 60. But what is noteworthy is that women in particular, and women under 50 or 60 in particular, have more severe adverse events with TTS. Four of the five deaths have been in women. That pattern is similar to that observed in the UK.

Senator WATT: Thanks for that. Professor Cheng, I think you pretty much indicated in answer to Senator Siewert earlier that it's not likely that ATAGI will be providing any changed advice on AstraZeneca in the immediate future, whether it be in response to the TGA's report or anything else. Is that right?

Prof. Cheng : Yes, although I would emphasise that the risks of TTS are now becoming known, or at least the estimates of the risk are becoming more precise. Obviously the other side of that equation, the benefit, is very different in different parts of the country at the moment. The benefit for someone being vaccinated in Sydney is very different to someone in Western Australia, for example.

Senator WATT: Sure. I'll come back to that.

Prof. Cheng : So that's the basis of our advice from 13 July. In that context, people need to consider that.

Senator WATT: Yes, I will come back to that point in just a moment. Before I do, I come to the point about community pharmacies. This is probably best for Dr Kelly. Yesterday the Prime Minister indicated that community pharmacies across the country will be eligible to request participation in administering AstraZeneca to the Australian population. Was any medical advice provided to government regarding the expansion of informed consent consultation through Medicare to community pharmacists?

Prof. Kelly : I'm probably not the best person to answer that part about Medicare, but certainly, yes, I can absolutely say that medical advice was sought. But my colleagues here would have more to say about the actual mechanisms of how that's going to work.

Senator WATT: Probably all I really need to know is that advice was provided, and it sounds like it was. Dr Cheng, is the ATAGI advice to government that pharmacists can give informed consent for those under 60 years of age who want to get AstraZeneca?

Prof. Cheng : We've not provided advice on who can give informed consent. In our recommendations from 8 April, we recommended that the Department of Health develop and refine resources for informed consent that clearly convey the benefits and risks, but not who is able to give that. Clearly that is a matter of preference for the consumer as well as whoever is providing that advice to make sure that they are confident that the consumer, their patient, is aware of what the risks and benefits are.

Senator WATT: Right. Back to the department, then, in that case: if ATAGI hasn't provided advice to government about pharmacists being able to provide informed consent for those under 60, has the department provided any advice to government about that?

Dr De Toca : The advice from ATAGI about obtaining informed consent from a health professional is what has been included in the communications from the department. The informed consent—which is a process, not a form—happens through a variety of health professionals, and the GP-led parts of the rollout also have a multidisciplinary team that includes nurses and other professionals, including pharmacists. The clinical governance arrangements for community pharmacists to form part of the rollout are being governed by state and territory regulation, and the Department of Health has been working with each state and territory for the framework that supports and governs clinical conduct in the community pharmacy rollout. There are some states that have granted broad regulatory approval for accredited pharmacists to provide both vaccines in different settings. Some states have restricted it to particular age groups such as people aged 60 years and over. That is a joint process, but ultimately the regulation of authorised immunisers is governed by each state and territory jurisdiction.

Senator WATT: Right. So I suppose the bottom line is: by the time we see community pharmacists rolling out AstraZeneca, will the systems be put in place for consumers to obtain informed consent and provide informed consent if they get that vaccine through a community pharmacy?

Dr De Toca : Every clinical encounter of this nature, whether it's over 60 or under 60, requires informed consent. The clinical governance arrangements that have been put in place for the community pharmacy aspect of the rollout are not dissimilar to other parts of the rollout. Community pharmacies went through a process of meeting requirements of ATAGI and a pretty robust assessment by the pharmacy program administrator, and those pharmacies that were deemed suitable are the ones that have been approached initially as part of that rollout. The specific regulatory arrangements for community pharmacy and for pharmacists' administration of the vaccine are done in partnership but are ultimately determined by each state and territory government. There is no part of the rollout that takes place that is not governed by strict clinical governance arrangements according to local jurisdictional regulation.

Senator WATT: Okay. I come back to ATAGI advice. Dr Cheng or Dr Blyth, has ATAGI been required to hold any urgent meetings to consider advice at the request of the Prime Minister or others in government?

Prof. Cheng : We've been requested to meet weekly by government, and we have been doing that. Obviously, as the situation changed, particularly around 2 April and 8 April with the first cases of TTS that were reported then, everyone came to the realisation that we needed to review that evidence very quickly. I think that was at the request of AHPPC.

Senator WATT: Have there been any requests directly from the Prime Minister or ministers to hold meetings outside the weekly process?

Prof. Cheng : I'm just trying to think of—early on, particularly, we had met. That was before we were asked to meet weekly. I'm not sure that we have been asked to meet outside of that.

Dr Blyth : Allen, I can jump in there as well. We have had additional meetings—for example, a meeting on 12 July, which was the Monday—particularly to review the outbreak in New South Wales. Clearly, we are watching the epidemiology very closely at this stage, and so that was a meeting to look at whether [inaudible] advice was required, which was subsequently published last week.

Senator WATT: The reason I ask is that, a couple of days ago, the Prime Minister said in a press conference that, 'it's a constant appeal', that he and others are making a constant appeal, to ATAGI to review their advice on the basis of circumstances that are arising. Has that been your experience, that there's been a constant appeal, whether it be from the Prime Minister or other ministers?

Prof. Cheng : I had interpreted that to mean that we were being asked to keep a very close eye on developments, both in terms of the changing epidemiology of COVID in Australia and emerging evidence of TTS. We have done that. That's not based on personal representation or anything from the Prime Minister, but I understand that we are expected and we have been keeping a very close eye on the situation.

Senator WATT: So any decision of ATAGI to review its advice has been by its own decision rather than as a result of appeals from the Prime Minister or others?

Dr Blyth : We're in constant communication particularly with the department, so we understand the pressure that is being put upon this committee. We meet regularly, and on an ad hoc basis as well, if there are things to be considered.

Senator WATT: In brief terms, can you explain to us why it's important that the advice ATAGI provides is independent of government.

Prof. Cheng : I would say that the advice that we're being asked to consider is of a very highly technical nature. We have had to understand this TTS syndrome. We have to understand the epidemiology of it. We have to understand what are the risks and whether there are particular risk factors, and age, gender and so on are part of that. Then we have to weigh that up against the other considerations. I think it would be fair to say that they are highly technical considerations that do require expertise, and that there is a process to obtain that expertise. For vaccines it's through ATAGI, but for other matters there are other expert committees for that.

Senator WATT: You probably would have seen that the Prime Minister told reporters yesterday: 'I want to get AstraZeneca vaccines in people's arms to protect them, their families and their communities,' and went on to talk about that. Does ATAGI consider that those statements are consistent with its health advice?

Prof. Cheng : We have said from the beginning that there is a group in which the benefit of AstraZeneca well and truly outweighs the risks from that, and at the moment that is everyone over 60. So for anyone who is over 60, particularly those who are in Sydney at the moment, we would very strongly recommend, and recommend even more strongly than before, that they get vaccinated with the available vaccine, which is AstraZeneca. We've also said that for all the other groups, people who are in priority groups—healthcare workers and so on—they need to be supported and we would really urge them to be vaccinated as well with the available vaccine for them. For people under 60, that would be Pfizer. But in the context of an outbreak where the risks and benefits are changing, we try to provide advice for all of Australia. If you're a farmer in Western Australia who goes to the town once a week, your risk of getting COVID is very, very small. It's not zero, but it's very, very small. The benefits of vaccination and the risk-benefit assessment in that context are very different if you're a taxidriver in Fairfield or Blacktown at the moment. That's the struggle we're trying to convey, but, because of that changing epidemiology, particularly in Sydney, we would really urge everyone who is under 60 who either has access to Pfizer, who is already booked in, or people that don't have access to Pfizer—they really should think about that actively to see if the risks and benefits are such that they should be vaccinated.

Senator WATT: I had a look at the advice that you provided on 13 July. In essence, as you say there, it's basically saying that people who are under 60 who do not have immediate access to Pfizer should reassess the benefits of AstraZeneca. So really the reason that people are being encouraged to reconsider AstraZeneca is the lack of Pfizer. If we had enough Pfizer, people wouldn't be required to make this choice, would they?

Dr Blyth : The reconsideration is also because clearly the epidemiology is changing. People may have come to the conclusion a month or two ago that, in the changing epidemiological context, those risks have changed. What we're really asking people, imploring people, particularly in those higher-risk areas, is to be aware that your risks are changing and they will continue to change as the epidemiology changes. You need to constantly reassess your risks, and that is your risks of getting COVID and your ability to access vaccine.

Senator WATT: There's been a bit of commentary and confusion about the vaccines that pregnant women should be taking. Is ATAGI considering putting pregnant women in phase b, and, if not, why not?

Prof. Cheng : I understand that that decision was noted by national cabinet, and pregnant women will be part of phase 1b.

Senator WATT: That decision has been made?

Prof. Cheng : Yes. The consideration early on, before large numbers of pregnant women had been given a vaccine, was that there was some uncertainty about the risks and benefits in that context. But there have now been quite large studies that have looked at the safety of COVID vaccines in pregnancy, as well as further data about the risks of COVID to pregnant women, and the risk-benefit is now more clearly on the side of getting pregnant women vaccinated.

Senator WATT: So pregnant women are now in phase b?

Prof. Cheng : I understand that's being operationalised at the moment. The general might be able to shed light on that.

Dr De Toca : Yes, and communication has gone out to general practice, initially via GP webinar yesterday, and throughout last night and this morning through a bulletin to all general practices, confirming the eligibility of all pregnant women, in line with ATAGI's advice and the national cabinet decision. So all pregnant women, regardless of their stage of pregnancy and whether they're eligible for other reasons or not, can access their vaccine through the primary-care channels.

CHAIR: Senator Watt, I'll have to leave it there. Senator Patrick, you've got questions for ATAGI?

Senator PATRICK: I'll start with ATAGI first. I've only got a couple. They go to mixed-dose schedules and whether or not we're considering those. Canada, for example, have AstraZeneca for a first dose, and then you turn up for Pfizer four weeks later as opposed to having the 12-week delay. What's happening in that space for Australia?

Dr Blyth : We are watching these data very closely. As you're aware, a number of countries have got mixed-dose programs running at this stage. We have issued advice that there are specific indications for mixing, such as for those who have had a previous adverse reaction to their first dose or where specific conditions were contingent on mixed dosing as part of a more general program. We will issue advice about that in the future, but what we are recommending at the moment is that the best approach for the Australian situation, given the quality of the data we have and importantly the supply we have, is to use the same one for the second dose. That's why we're really strengthening the recommendations. If you've had an AstraZeneca dose first, particularly in an outbreak situation, you need to be coming forward for your second dose. But ATAGI is watching what's happening internationally and viewing the data about the mixing and matching of programs.

Senator PATRICK: So, again, that simply comes down to the lack of supply, because it's clear that, if you can get people double vaccinated in four weeks, even if they start out with AstraZeneca, it might help the situation, for example, in New South Wales.

Dr Blyth : I think it's more complex than supply, with respect, Senator. Firstly, there's always a supply issue, but it's also about where the data is at the moment. As you've seen, a number of countries are moving to this, but some countries have not moved to this. We are watching this closely.

Senator PATRICK: Noting that there was a call from the New South Wales Premier today to treat New South Wales differently in the regional response, recognising their circumstances are different to everyone else, surely that has to be something that would need to be considered. You'd have to be providing advice to national cabinet in relation to that, because it is a way of expediting protection.

Dr Blyth : We have provided advice previously, and in our statement on the 13th, to say that any additional unallocated supplies of vaccines of either type should go to outbreak areas, but the operationalisation of that is probably best spoken to by the department rather than ATAGI. ATAGI is very much focused on trying to make sure that those areas at greatest risk have as much possible protection as possible.

Senator PATRICK: Sure. But ATAGI's role here, rather than the operationalisation of the vaccine, is certainly to give advice as to the suitability of these mixed doses.

Prof. Cheng : Sorry, I may have misunderstood your question. We have provided advice on bringing forward the second dose of AstraZeneca to between four and eight weeks to try and improve the protection it provides against particularly the Delta strain. We understand 'mixed doses' to mean one dose of Pfizer and a second dose of AstraZeneca or vice versa. We don't recommend that at this stage partly because the weight of evidence is not there to support that. There are trials of tens of thousands and millions of people that have received two doses of the same vaccine but only probably a few hundred that have received a mixed schedule—one dose of one and another dose of another. There are obviously reasons why some people may need to do that. If you had a severe allergic reaction to your first vaccine, you can't get that one again. That's a perfectly valid reason why we might support mixed schedules, but not as a routine.

Senator PATRICK: I have one last question for ATAGI, and then I'll move elsewhere. What's the latency between an AstraZeneca first jab and/or a Pfizer first jab and some effectiveness?

Prof. Cheng : The data suggests that protection starts about 21 days from the first dose of AstraZeneca, and for Pfizer it's about 14 days after the first dose.

Senator PATRICK: That perhaps again lends weight to what the New South Wales Premier is suggesting—that you need to get Pfizer into New South Wales. I'm not suggesting that's the right answer, but there would be some scientific basis around her call.

Prof. Cheng : The priority would be to get a first dose of any vaccine into anyone, and, whether that seven-day difference makes a huge difference to public health control, I'm not so sure about that.

Senator PATRICK: Okay. Thank you. That's it for ATAGI for me, Chair, if you want to release them.

CHAIR: Senator Davey has a couple of quick questions, I understand.

Senator DAVEY: To ATAGI: I just want to get a bit of an understanding of your broader work. When you're providing advice for other vaccinations such as flu shots, do you provide advice regarding which shot might be better for different demographics with other vaccinations?

Dr Blyth : I'm happy to answer that. Yes, we do. The flu is a good example. We recommend one vaccine such as an adjuvanted influenza vaccine for older people, because we think that's more suited to older people. We recommend a different vaccine for children and young adults. ATAGI's role is to look at the evidence supporting one type of vaccine over another and to align that with different population groups, whether that be by age or by risk factor.

Senator DAVEY: We get flu shots through pharmacies as well. So you provide that advice, and that goes out to pharmacies, to all the GP practitioners and to wherever you can get those vaccinations?

Dr Blyth : That's right.

Senator DAVEY: Thank you.

CHAIR: That means witnesses from ATAGI can depart now. Thank you very much for your time today and for your assistance with the committee's work. It is much appreciated.

Senator PATRICK: In relation to the minister's claim about Pfizer arriving last week and this week, can you give me the actual numbers of what arrived last week and what arrived this week?

CHAIR: In terms of whole of population?

Senator PATRICK: No—just understanding what arrived in country. The minister had suggested a certain amount. I want to know the actual amount.

CHAIR: The million doses, yes.

Lt Gen. Frewen : We'll get that very specific information. It's just coming into the room.

Senator PATRICK: Where did that arrive? Was it New South Wales or Victoria? Where is it physically located?

Lt Gen. Frewen : It physically came into Sydney, Perth and Melbourne.

Senator PATRICK: Noting that you had a plan for a rollout of only 300,000, and that we've now had an extension to a million, what are you intending to do with the additional 700,000? How are you distributing that?

Lt Gen. Frewen : We pre-made those distributions on the advice of the confirmed delivery schedules, and, as per current arrangements, the allocations were made proportionately across the states and territories on a per capita basis. We made a distribution through state networks and through GP networks.

Senator PATRICK: There is now being put out by the New South Wales Premier—there have been some interesting press conferences today across both New South Wales and Victoria. I presume there must be some planning in place, some modelling, as to whether or not to approach the Pfizer vaccine rollout on a regional basis in circumstances where we have what is happening in Sydney. There must have been some consideration or some modelling of that. Is that the case?

Lt Gen. Frewen : I wouldn't categorise that modelling as occurring. We are doing a national vaccination program. It is important that we vaccinate the entire nation concurrently. In relation to hotspot management: as I said to the committee earlier today, vaccination is but one part of how to approach hotspot management. Lockdowns are fundamentally important; testing, tracing and isolation have remained essential throughout this pandemic; and then there are other measures such as social distancing, masking and all of that.

Vaccination underpins the national resilience to COVID. It is not the best way to provide an immediate health response to an outbreak like this. Our priority for dealing with an immediate outbreak like this in terms of vaccinations is to go to the most vulnerable communities, and that is what we have done. We have deployed roving clinics into the aged-care sector specifically, to make sure we have got the highest possible levels of vaccination in the aged-care sector. At the moment we are working on encouraging all those over 70 to get their dosages done with AstraZeneca if they haven't done so already, and we've spoken to some of the other high-priority cohorts to whom we are seeking to provide additional vaccines. But suddenly deciding to throw a particular vaccine at one geographic area does not give you an immediate solution to a problem.

Senator PATRICK: So, if we see that answer come out of national cabinet, it will do so not on advice from the department?

Lt Gen. Frewen : The Pfizer vaccine is provided on a per capita basis. To get reallocation of Pfizer from other jurisdictions would require the concurrence of the other jurisdictions; that would be the sort of conversation that might take place. At the moment I am not aware of New South Wales making a case to the other jurisdictions as to why other jurisdictions would seek to prioritise their Pfizer to New South Wales.

Senator PATRICK: That just seems to have been the nature of the press conference. I'll go very quickly to Dr Murphy. You indicated sorrow in relation to the way in which this has panned out. Are you reflecting on how this has occurred? If so, what are the things that you would have done differently? If you're not reflecting on it, why not?

Dr Murphy : Of course we reflect on decisions, and the expert panel that has made advice on purchases has also reflected on decisions. One can always use retrospection, but, on the basis of the evidence and the data that we had at the time we made our initial purchases, I think the Scientific and Technical Advisory Committee feels that it made the right decisions at that time. If we'd known that AstraZeneca was going to have this clotting issue our decisions might have been different at the time, but one can't always predict the future. We had a diversity and a redundancy of supply, and a strong dependence on local production. The Scientific and Technical Advisory Committee, the large committee of experts, feel that the decisions made on the basis of evidence at the time were the right ones.

CHAIR: Senator Patrick, we'll leave it there. So, Lieutenant General, based on your answers to Senator Patrick, there is no extra Pfizer available to go to New South Wales that hasn't already been allocated across the country?

Lt Gen. Frewen : From time to time we have minor amounts of Pfizer that are available because of unders and overs, and we manage those on a case-by-case basis. I currently have a formal request from South Australia for additional Pfizer. At the moment I don't have a formal request from New South Wales for additional Pfizer. I've had informal requests.

CHAIR: It seems pretty formal today.

Lt Gen. Frewen : I don't take requests through the media.

CHAIR: Fair enough. But you don't have your general reserve of Pfizer?

Lt Gen. Frewen : Not at the moment, no. That's part of the new campaign plan.

CHAIR: There's no covered—

Lt Gen. Frewen : No. We've got AstraZeneca, and we are working hard to get much AstraZeneca into New South Wales right now.

CHAIR: On your campaign plan that you're going to take to national cabinet, and the operational review of the vaccine program: you say you're going to release the plan, but are you going to release the operational review of the vaccine program?

Lt Gen. Frewen : The plan is the result of my review.

CHAIR: But the review itself? Presumably there's a review that has led to the campaign plan? That's how it reads in your opening statement.

Lt Gen. Frewen : The review was the process that we went through to write the plan.

CHAIR: So there's no review document?

Lt Gen. Frewen : No.

CHAIR: So the campaign plan will be released following national cabinet; is that your intention?

Lt Gen. Frewen : It will be released as soon as I'm able to release it after national cabinet. There are a couple of things now, like the recent advice on 12- to 15-year-olds and Pfizer—so we will wait for the formal advice on that, and then we may seek to make some adjustments to the plan, and then, as soon as we can after that, I intend to release it.

CHAIR: But it's not a decision of national cabinet to release it? It's your decision?

Lt Gen. Frewen : No, it's going to national cabinet for noting this afternoon.

CHAIR: Thank you.

Senator SIEWERT: Can I go back to where we left off in terms of home-care workers. Professor Kelly, you were making the point earlier around AHPPC advice. Have you gone back to the AHPPC in light of the delta variant spreading in three states now? Have you gone back to them to seek advice on whether home-care aged-care workers and disability workers should now be high priority and, in fact, be mandated for vaccination—so that vaccination be mandated for home-care workers in both the aged-care and disability sectors?

Prof. Kelly : It's ongoing discussion about prioritisation. I would reiterate what Dr Murphy said earlier that the highest priority within the priorities that we have were people in residential aged care and residential disability care. The reason for that is twofold. Firstly, they are vulnerable people because of their illness or age profile, but also because they're in the residence. It's that crowded nature—understanding that the virus moves between people—the more people you have in one area, the more vulnerable those people are. So they are definitely the key.

But then, as I said earlier, I've got this list of people that are priorities at the moment. So I've got: respiratory technicians and doctors in private practice; teachers and their families; construction workers; FIFO workers; freight drivers; airline employees, and flight crews in particular; employees of Wesfarmers, Coles and Woolies; cleaners in various high-risk settings; frontline emergency workers; call centre staff; families of healthcare workers; distribution centre workers; and Uber drivers and taxi drivers. That's just in the last week that people have come forward.

I think the point is that everyone is a priority right now. We need to get on with the vaccine rollout, and the quicker we do that, the better. Whilst we've got that eye on the vulnerable, there is also the transmission element that we're in Sydney in particular. Lieutenant General Frewen has already spoken about that and the discussions we're having with New South Wales to get specific information about that as well as protecting the vulnerable. So there are these multiple strands.

Senator SIEWERT: Thank you for that. You did not answer my question, however. Have you gone back to AHPPC for updated advice in terms of older Australians receiving home care and disabled people receiving care in the home? I'll come to congregate settings in a minute—and disabled people.

Prof. Kelly : So that is part of the advice we've provided to national cabinet on at least three occasions and we've been tasked to come back again with disability care in particular, and not just in residential care. So they are ongoing discussions. The last time we gave information to national cabinet—there have been quite a few meetings recently but I think it was about two weeks ago—was when delta was already here and already circulating, specifically in New South Wales. So it was in that context.

Senator SIEWERT: When can we expect to see further advice for home care and disabled people?

Prof. Kelly : In terms of disability care, that is coming back next month for further advice to national cabinet. In terms of home care, that's not specifically on the agenda, but it's something we're looking at continually.

Senator SIEWERT: Did you say home care is not actually on the agenda?

Prof. Kelly : They're a priority group, like all the other priority groups, but AHPPC has not been tasked to look specifically at home care; that's true.

Senator SIEWERT: I'm talking about workers. I understand older Australians are a priority. But are home-care workers a priority?

Prof. Kelly : Yes.

Senator SIEWERT: In terms of the advice on disability, are you providing it for workers who are caring for people at home and in congregate care?

Prof. Kelly : Yes.

Senator SIEWERT: What's the time frame? Are we talking about early next month?

Prof. Kelly : I only have August—next month—yes.

Senator SIEWERT: Can I go specifically to the issue around the Parklea group home where disabled people have contracted COVID. Can you tell me, firstly, how that outbreak occurred?

Prof. Kelly : I'll ask my colleague to come up.

Mr Mulhall : I have some notes on Parklea. If you give me one moment, please, I'll just find it in my notes and give you the detail.

Senator SIEWERT: Okay, thank you.

CHAIR: Do you have another question, Rachel, while—

Senator SIEWERT: Yes, I do. In terms of the number of people who had in-home care in New South Wales, do you have the figures on how many people have contracted COVID while getting home care?

Dr Murphy : We'll have to take that on notice, Senator. We have data on the residential care workforce. I'm not aware of home care workers contracting in New South Wales, but we'd have to take that on notice. If Professor Kelly doesn't know from his AHPPC discussions, we'd have to check with NSW Health. We do have good data on residential care workers, and there have been a number of those who have contracted COVID.

Senator SIEWERT: I'll come back to that in a minute. Could I please then ask, on notice, for home care workers and older people who are receiving the care.

Dr Murphy : We'll take that on notice, Senator.

Senator SIEWERT: Thank you. Can we then go back to the issue around Parklea, and then I'll come to other issues around aged care.

CHAIR: You've got about five minutes left, Senator Siewert.

Senator SIEWERT: Okay. I will have to put lots on notice.

Mr Mulhall : I have the information here. There are four group residences located alongside each other. There's a total of 21 residents within those four group homes. Of the 21 residents, 19 have had one dose and two declined to be vaccinated. Of those 19, 14 had AstraZeneca vaccinations through their local medical centre back in May, with the second dose already booked in for August. Since then, Aspen visited that same facility on 12 July and administered Pfizer to the balance of the residents, together with 10 staff.

Senator SIEWERT: Could you tell me how many people in Parklea have actually contracted COVID?

Mr Mulhall : My understanding—I don't have this morning's information, so forgive me if it has moved on since last evening. We understand three have tested positive and we're awaiting results for a further two.

Senator SIEWERT: How did COVID occur? How did the infection occur? How did it enter the facility?

Mr Mulhall : I don't have that information available to me. I'll take that on notice. I don't have that information with me.

Senator SIEWERT: Was it a worker?

Mr Mulhall : I don't have that information, Senator. I'll take that on notice.

Senator SIEWERT: Why don't you have that information? Surely this is vital information?

Mr Mulhall : Senator, the monitoring of individual cases is managed through the national disability quality and safety commission. I don't, as a matter of rule, track every case. Indeed, the task force does not track every case. I anticipated this question, but, to be frank, I don't have that individual personal information available to me. Given the question has come up, I will take it on notice.

CHAIR: Senator Siewert, I think the officer has agreed to take it on notice.

Prof. Kelly : Chair, if I may, there's an update on one of the previous questions from Senator Siewert. We understand there is one home care resident in the current New South Wales outbreak so far.

CHAIR: Senator Siewert, do you have a final question?

Senator SIEWERT: Just on that one: do we know how that home care resident contracted COVID?

Prof. Kelly : No, I don't.

Senator SIEWERT: Can you take it on notice?

Prof. Kelly : I will take it on notice.

CHAIR: Professor Kelly, you have to leave at 1.30, and I just have a few questions for you. I wrote to you the other day and you replied. Thank you very much. I will table that correspondence for the committee's benefit. I just have a couple of questions that come out of it. The ACT's been COVID-free for over a year, thankfully. We have many MPs in strict lockdown at the moment who arrived a week or five days ago. I am interested in the conditions around the Prime Minister's movements around Canberra. He's come from greater Sydney into the ACT and he's operating on a different set of arrangements than other MPs are allowed; they aren't really even allowed to open their doors. But I read your letter. Firstly, does the ACT government have to sign off on these conditions? If so, I note that in your letter you say you've reached a common understanding with Dr Coleman, but did you reach agreement? Did they sign off on the arrangements that were put in place for the Prime Minister?

Prof. Kelly : Thank you for your letter. I understand your concerns for ACT residents. I'm an ACT resident as well, so thank you for that. In terms of the understanding with the ACT Chief Health Officer, Dr Coleman and I speak on at least a daily basis, and quite a lot of that discussion is related to the safe operations of this place. The common agreement that I referred to in the letter was in relation to the Australian parliamentary house, not to the arrangements—

CHAIR: Not specifically the arrangements around the Prime Minister?

Prof. Kelly : Correct.

CHAIR: So you manage that? Is that under your responsibilities?

Prof. Kelly : You will understand specifically the statutory nature of the Chief Health Officer in the ACT and also the complexity of that arrangement in relation to the National Capital Authority. The way I look at it is that Dr Coleman has absolutely a very important statutory responsibility for the protection of the ACT population, many of whom work in APH. The presiding officers of APH as a workplace are the ones who have responsibility for safety within the house. I have no statutory responsibility, but from time to time I am asked for advice by the Prime Minister in relation to these matters, and so I provided that advice last weekend.

CHAIR: So you've provided the advice that the Prime Minister is, presumably, following in terms of how he's conducting himself and the arrangements that are put in place around him?

Prof. Kelly : Of course, advice is taken, and how that is then used is up to the individual who takes the advice.

CHAIR: Okay. I'm trying to understand how the way he's conducting himself is in adherence with the public health emergency direction that's been put in place by the Chief Heath Officer and which other MPs are abiding by strictly. You're saying there isn't really a legislative framework or a power for which that is operating; it's done through some goodwill and negotiations.

Prof. Kelly : Correct. The other document you have there in front of you is countersigned by me with Dr Coleman, and that relates to the protection of the ACT community. The letter that you've just tabled is specifically advice for the Prime Minister at his request.

CHAIR: How he's operating is different from when he's done his overseas travel, when he has remained at the Lodge. He is moving between the Lodge and here. Two days ago he did a press conference at the Lodge where a whole lot of people came into a quarantine zone. Presumably, someone's monitoring that and monitoring the people who came into the quarantine zone after they leave. Is that right? Will those who came in have to be subjected to any testing or monitoring?

Prof. Kelly : I gave advice along those lines on the weekend. How that's being operationalised and implemented is not my responsibility.

CHAIR: Whose is it to do the testing that's required under the other guidelines that have been issued for parliamentarians?

Prof. Kelly : The Prime Minister's office and Department of the Prime Minister and Cabinet are the ones who are responsible for that.

CHAIR: We've got these public health directions for essential parliamentary business which outline a range of things that have to happen and movements for people, including daily saliva testing. Do you know if that's happening?

Prof. Kelly : That was my advice specifically to the Prime Minister, as were those directions you have in your hand there.

CHAIR: But, as far as you know, no-one's monitoring that?

Prof. Kelly : Well, I'm not monitoring it.

CHAIR: So who would be doing it? Would that be the ACT government's responsibility?

Prof. Kelly : Putting the Prime Minister elements aside, for the parliamentarians themselves, yes, the ACT government are involved with that and monitoring.

CHAIR: For the Prime Minister?

Prof. Kelly : On the Prime Minister, I'm not involved with the implementation of those particular arrangements.

CHAIR: So we have someone who's undergoing quarantine here who's allowed to move from his place of residence to his workplace and have contact with other people. Have you met with the Prime Minister whilst he's been doing quarantine?

Prof. Kelly : No, I have not. In terms of the press conferences, you'll see outlined in my letter my advice about how to make that as safe as possible. They are held outside and people are wearing masks. It was suggested that people should be vaccinated and should be having daily tests. That was the advice I gave.

CHAIR: Yes, but you don't monitor that, because presumably some of those who went there weren't fully vaccinated.

Prof. Kelly : I have no way of knowing that.

CHAIR: Your job really is to provide advice, and then it's over to the Prime Minister and his staff about whether they follow it, and we don't know who's monitoring it at all?

Prof. Kelly : I'm not monitoring it. Could I just say that there are constitutional issues here in terms of the ability of—

CHAIR: I'm aware of those. It's just that all the colleagues of mine and presumably the government who are locked up and following this—there are a lot of them who are locked up who are not allowed to leave or who are not leaving their apartment. I'm trying to understand what the rules are for the Prime Minister—for example, I think part of your letter was that, to minimise travel and impact on APH, the press conference should be at the Lodge, yet the Prime Minister came to Parliament House that afternoon to take part in the Olympic announcement. How is the spirit of your letter being met by that approach, where it's not minimising travel and in fact we brought a whole lot of people who are in APH down into a quarantine zone who then returned to APH?

Prof. Kelly : I would categorise the quarantine zone as being inside the lodge. The point is I've provided advice on this, but in terms of decisions made in terms of what is or isn't parliamentary business as it is suggested in the Constitution exactly—I'm not a constitutional lawyer, but there are parts of the Constitution which actually say that no-one has the power to stop MPs doing what they need to do to run the country.

CHAIR: No, but throughout the pandemic we've all copped the fact that we should, in the interests of keeping communities safe, take the health advice. Your health advice is outlined, but we don't know whether the Prime Minister has been taking it. But we do know that every other MP in quarantine is doing it, because they're getting checked by the police and by ACT Health through testing arrangements.

Prof. Kelly : I really thank them for doing that. It is keeping the ACT population safe.

CHAIR: We have 14 million Australians in lockdown trying to follow the rules, yet we don't know if the Prime Minister has been following the rules, and we don't know whether he's having testing or any of the other advice that was put in your letter—or anyone who's having contact. I'm presuming he's having contact with quite a lot of people.

Prof. Kelly : As you'll see in the letter, I advised that that should be kept to an absolute minimum. The reality is that, in all the places that are currently under lockdown, there are exemptions for essential work. The question is about the nature of that essential work. It is the nature specifically of the Parliamentary Triangle which makes those sorts of decisions difficult. That's why we do it in collaboration with ACT Health with advice to make it as safe as possible, as I have given.

CHAIR: To finish this: you provide advice but there is no role under your responsibilities to monitor if that advice has been adhered to, and, as we know, unless ACT Health are doing it, no-one is monitoring that advice?

Prof. Kelly : ACT Health does have a role in some of those testing arrangements, but just to make it clear: that advice is my advice, not from ACT Health.

CHAIR: ACT Health and the chief health officer have not agreed or signed off on the advice that you provided for the Prime Minister?

Prof. Kelly : I have informed the ACT chief health officer about that advice. As I say, I'm in very close and frequent communication with her. That was the advice I was asked—

CHAIR: She didn't agree to it; it was, 'Here is the advice'?

Prof. Kelly : It was my advice as requested.

CHAIR: Did you provide her with a copy of it?

Prof. Kelly : No. She was not provided with a copy.

CHAIR: Why is that?

Prof. Kelly : It was advice to the Prime Minister under his request from his chief medical officer. It was advice to him.

CHAIR: I think people in quarantine will find that really difficult to understand.

Senator KENEALLY: Thank you to the officials. I have some questions in relation to quarantine. To Professor Kelly first. At the 27 April hearing of this committee your evidence was that hotel quarantine was fit for purpose in your professional opinion. Given that we have almost 14 million Australians now in lockdown and a highly infectious Delta variant, is that still your professional opinion?

Prof. Kelly : Yes, it is.

Senator KENEALLY: So you are not changing any of your current medical advice on the appropriateness of the continued use of hotel quarantine?

Prof. Kelly : No, I'm not. We've given advice on many occasions—in fact, I would suggest on every occasion we've appeared before this committee and other Senate committees in recent months—to that effect. I don't see any reason to change that advice. I will reiterate what Dr Murphy has already mentioned, that the current situation in New South Wales was about a limousine driver who should have been vaccinated, should have been wearing a mask, should have been having daily testing and was not. That would have been the same wherever that person was working in relation to people arriving from overseas. It had nothing to do with hotel quarantine.

The case that has caused the outbreak in South Australia was someone who had returned from South America, who had gone successfully through their 14 days of hotel quarantine—the only hitch being that they were unwell and needed to get a hospital—contracted the Delta virus from the outbreak in Sydney, not in hotel quarantine, and took that into South Australia. The Victorian outbreak, as has been very widely talked about, started with a removalist van coming from south-west Sydney—nothing to do with hotel quarantine. I reject the conjecture that 14 million Australians—my heart goes out to them about the lockdown—are in lockdown due to a failure of hotel quarantine. It is patently false.

Senator KENEALLY: Notwithstanding the evidence you just provided, we have had 26 breaches from hotel quarantine. I am going to come to the transport workers, the limo driver and the other in a moment. We have had leakage from hotel quarantine. If it is the case that hotel quarantine remains fit for purpose, why have the caps on international arrivals been halved?

Prof. Kelly : That was a decision of national cabinet. I'm not going into why the decision was brought to be, because it's a cabinet-in-confidence matter. However, I was asked by the Prime Minister, prior to national cabinet, about my opinion on caps. I did offer what is the fairly obvious suggestion: that if you decrease the number of people coming in you would decrease the number of people who are positive for the virus and decrease the opportunity for the virus to be transmitted into the community. I would reiterate that the decision about caps was a national cabinet decision agreed by the premiers, chief ministers and the Prime Minister.

Senator KENEALLY: It does seem somewhat contradictory to say you have this fit-for-purpose—in your advice and Dr Murphy's advice—perfectly safe system of hotel quarantine yet we have to halve the number of arrivals, particularly at a time when we have 36,000 Australians still stranded overseas. Let me ask you this, then: if hotel quarantine remains fit for purpose, why has the Commonwealth resolved to build facilities in Mickleham, the army barracks in Queensland and in Western Australia?

Prof. Kelly : Firstly, to take you up there, Senator Keneally: I and I'm sure Dr Murphy have never said that it's perfect. No system which is as complex as the hotel quarantine system or the quarantine system more broadly, including the Howard Springs dedicated facility, would be seen as perfect. They certainly are extremely complex, and throughout those breaches that you mentioned we've seen multiple reasons why those breaches have occurred. As I've given extensive evidence on to this committee previously, we have a continuous quality improvement approach through the Australian Health Protection Principal Committee. As recently as yesterday, we had a dedicated meeting to talk about quarantine and what has been learnt. That announcement from national cabinet about the decrease in the caps also included an announcement about a second Halton review, and that's already underway.

Senator KENEALLY: I was going to ask about that. What is the status of that work, and when do you anticipate that it will be completed?

Prof. Kelly : That's being run through Prime Minister and Cabinet, so I don't have the details, but I did talk to my colleagues yesterday. At the moment she is forming her team. Last time she did it, it was an excellent piece of work which has really guided a lot of the work in quarantine since then. She has her team together, and my understanding is that that work will start very soon—the actual review.

Senator KENEALLY: Thank you. Can I touch on the first Halton review. In her review of hotel quarantine, she specifically mentioned transport. She thought it was a vulnerable part of the hotel quarantine system, and she particularly mentioned it. What I don't quite understand is why a number of the recommendations of the Halton report haven't been implemented, particularly around transport. Do you have any visibility or understanding of why we've got transport workers unvaccinated, as we did in Bondi and as we did in Berowra in the January cluster, which was linked to a transport worker? We've never really found out the source of the Avalon cluster, which had 150 cases in New South Wales over Christmas, but it was suspected to be linked to transport or hotel quarantine of international crew. Have you had any advice to government urging any improvement or requirements around that aspect of the quarantine system, the transport workers?

Prof. Kelly : Absolutely. It's been part of all of the work we've done through AHPPC to see what improvement we can make in safety. One of the key elements, absolutely—and this was at the behest of the premiers, in fact—was to make sure that, from the very first tranche of the Pfizer vaccine that came in February, a specific portion of that would go to vaccinate the quarantine system, from transport through to the hotels and anyone associated with that. So it is very disappointing that that limousine driver had not been included in that rollout.

Senator KENEALLY: It was back in September when Ms Halton delivered her report. Page 23 of her report has a heading of 'What does "good" look like?', under which she talks about transfer. She says:

Best practice also recognises risk and that travelers may be COVID-19 positive … . The same principles extend to the transit passengers …

This was in September. We are now in July. I'm in New South Wales, completely locked down. It's incredibly frustrating that we're in this circumstance. The state premiers have repeatedly said it's because they do not have enough supply. I have to say that, while I take on board your advice that people should get vaccinated, as someone who's tried to get vaccinated here in New South Wales I have to agree with Brad Hazzard: trying to get a booking is like The Hunger Games. So my frustration here is trying to understand why the Commonwealth hasn't moved faster to implement that aspect of the Halton report.

Dr Murphy : I might intervene here. NSW Health has acknowledged that this was a failure of the public health oversight. That limousine driver had plenty of access to vaccine. There was never a suggestion from NSW Health that there was a vaccine supply issue. That was a failure of their protocols. They had protocols that these people should be vaccinated and that they should be tested daily, and this particular contractor failed to adhere to that. They have ensured now that those failures have been addressed. It was a human failure—nothing to do with availability.

Senator KENEALLY: Do you know that for certain? The police have declined to press any charges.

Prof. Kelly : I do know for certain. There was a complex contractual arrangement with that particular driver, which meant that they were several steps away from what had absolutely been guaranteed to us, and had been guaranteed within the New South Wales complex system of quarantine, that everyone had been vaccinated, that everyone was adhering to wearing masks and other personal protective equipment elements, and everyone was being tested daily. That's the other element we brought in after the Halton review. Unfortunately, none of those things were happening with that particular driver. Now, pressing charges and so forth is obviously an element for the New South Wales Police, but I believe that three-times-removed contracting element was probably part of the issue. It is possible that he did not know about those matters needing to be done.

CHAIR: Senator Keneally, we have five minutes until Professor Kelly and General Frewen—

Senator KENEALLY: Thank you, and I'm aware that Senator Watt may also want to ask a question before this block of time wraps up. You said a moment ago—I think it was you, Professor Kelly—that if you reduce the number of people, you reduce the risk of the virus coming into the country. I note there has been a lot of public outcry in the last few days over celebrities coming into the country. Katie Hopkins has been a notable case. She, of course, has been sent home. There's speculation that Thomas Markle, a brother of Meghan Markle, has been allowed to come into the country. Apparently Caitlyn Jenner is currently in quarantine. They're apparently all here for television show purposes. Channel 7 says they're not taking up spots available to stranded Australians or part of the international arrival caps; they are additional, and they have been 'granted an exemption by the government'. Have you given any advice to the government in relation to reducing the number of celebrities that are allowed to come into Australia?

Prof. Kelly : Senator Keneally, I'm sure you're aware that it's the Australian Border Force Commissioner who makes those exemptions, not me. I don't have an opinion one way or the other, or any powers to influence it.

Senator KENEALLY: Oh, come on. You would have a view. You just said your advice to the Prime Minister on reducing the caps on international arrivals would be that if you reduce the number of people coming into the country, you reduce the risk of the virus coming out. But we now know that there are groups of people who get to come into the country, above the caps, and they are given exemptions by the government. I'm just wondering if there has been any advice to the Prime Minister about seeking to reduce the number of people who fit into this special privileged category of getting to come into Australia.

Prof. Kelly : There have been many discussions about the categories themselves; but, as I said, that's not under my power. I stand by my advice that the fewer people coming into Australia from high-risk countries would decrease the number of positives, and that would decrease the risk. How that's calculated as to who comes, that's not my decision.

Senator KENEALLY: Okay. We might take that up with Border Force. Thank you.

CHAIR: I'm going to have to let Professor Kelly and General Frewen go. They have other matters to attend to. General Frewen, one final question from me as you pack up your belongings. Is there an operational plan for aged home care that you're putting in place?

Lt Gen. Frewen : No, I'm specifically focused on the aged-care workers at this time.

CHAIR: In residential aged care?

Lt Gen. Frewen : Yes.

CHAIR: Because there are aged-care workers going into home care. So there's no plan at the moment?

Lt Gen. Frewen : Not a specific plan for that. I've got a specific plan to work on the residential aged-care workers who are now subject to mandatory vaccination requirements by mid-September.

CHAIR: Are you going to put one in place?

Lt Gen. Frewen : I will look to what requirements there are, Senator.

CHAIR: Okay, so it hasn't been part of your work to date?

Lt Gen. Frewen : Not a focused effort at the moment.

Dr Murphy : But those workers are freely able to access vaccines at all of the potential sites of vaccination at the moment, and they're being encouraged to do so.

Ms Blewitt : We can't necessarily identify everybody, so we're looking at matching the Australian Immunisation Register data, first of all. As Professor Murphy said, they have access to all channels and we continue to encourage them, but we have to be able to track them as well.

CHAIR: Ms Blewitt, are you staying?

Ms Blewitt : Yes.

CHAIR: You work with General Frewen. Is that right?

Ms Blewitt : I do.

CHAIR: He did take on notice the doses for Senator Patrick—the actual dose arrival. I'm not sure if that answer is available.

Ms Blewitt : I'll see if I can track it down.

CHAIR: It would be good if you could do that by the end of the hearing. Senator Watt, I'll go to you and then I'll do a final 'round the ground.

Senator WATT: Thanks, Chair. I have a couple more about quarantine, but, on the home-care workers, Dr Murphy, how many home-care package recipients are there in Australia? It must be in the tens of thousands, at least.

Dr Murphy : It is. I don't have the exact current data with me, but there are a large number of people on home-care packages, yes.

Senator WATT: The vaccination of workers providing services in the home to at least tens of thousands of older Australians is not currently a focus for government, based on what—

Dr Murphy : It is a focus.

Senator WATT: General Frewen just said that there's no plan.

Dr Murphy : There's no plan to proactively ramp up, as there is for the residential aged-care workers, but the home-care workers are included in the phase 1 priority. They have access to every single point of vaccine presence, whatever their age, and they are encouraged to seek out those vaccines at their GPs, at the state clinics and at the pop-up clinics that we're setting up for aged-care workers. They are being given plenty of access and encouragement to get vaccinated—

Senator WATT: But that's been the approach all along, Dr Murphy—that people have had access—and so far it's seen less than 30 per cent of aged-care workers, overall, vaccinated. That approach just hasn't worked.

Dr Murphy : It is working now. We're seeing a significant rise in the vaccination rates of aged-care workers generally. Most specifically we are focusing now on the residential aged-care worker group, because they're at the highest risk, but that's not to say that home-care workers are not a very significant priority. Once we've completed the inreach to aged-care workers, if there is still an issue with home-care workers, we will develop specific strategies to enhance that.

Senator WATT: To go back to quarantine, the government sent, I think, a two-page letter to the Queensland government a few weeks ago, proposing a site at Pinkenba near Brisbane Airport. I take it there is now a joint assessment underway between the state and federal governments about that site?

Dr Murphy : That's correct. The Department of Finance is leading on that, but Mr McBride is involved in that process and can provide more information. But there is a joint assessment underway, led by the Department of Finance.

Senator WATT: In the interests of time, I might ask a couple of particular questions. What was the Department of Health's role in assessing the suitability of this site?

Dr Murphy : Our role the whole way through has been to have strong input into the design guidelines for any such facility and the infection control requirements for such a facility. The chief nursing officer, Professor Alison McMillan, has been heavily involved in the design guidelines. They were initially for Victorian facilities, but they will be generalised for other facilities. Mr McBride might have something further to add.

Mr McBride : No, I have nothing to add.

Senator WATT: Again, I realise this might involve other departments, but what sort of assessment of the suitability of this site was undertaken prior to its being suggested by the Prime Minister?

Dr Murphy : We have to refer you to the Department of Finance on that, Senator, because they were the department that identified it as a potential site.

Senator WATT: Okay. If we just deal with health matters, I can see some benefits in having a site near or right next to an international airport, but there'd certainly have to be some health and safety issues, one would think, about a site adjoining an international airport, whether it be about aircraft noise or air quality or even where planes land in relation to accommodation and how close it is. Is your department involved in assessing any of those issues?

Dr Murphy : We're providing health advice as requested by the Department of Finance, but they are leading on those assessments.

Senator WATT: From a health point of view, had the department raised any concerns about health issues from this particular site?

Mr McBride : We meet regularly with the Department of Finance as part of this process, so all the things that you mentioned are being considered by them as part of the assessment process, some with more influence from us than others. Professor Murphy mentioned the work that Professor McMillan is undertaking—but all those things are being considered. OH&S, noise and all those sorts of things will be part of the consideration, but Finance is leading that.

Senator WATT: What concerns does the department have, from a health point of view, about that particular site?

Mr McBride : Our health assessment process is to make sure it operates effectively as a quarantine facility. That's the work that Professor McMillan is undertaking.

Senator WATT: Sure, I know that's your role, but I'm asking whether you have raised any concerns from a health point of view with the Department of Finance.

Mr McBride : They have pretty strict assessment processes that build those into them. They're looking at air quality, at soil quality, at noise quality. They're doing all the normal things that you would go through in building a facility. Now, that facility will have a specific purpose, obviously, so our addition hours to is that—

Senator WATT: I know. I've asked three or four times know whether the department has raised any concerns. I understand there's a process underway. What I would like to know is whether your department has raised any concerns, from a health point of view, about that site.

Mr McBride : No.

Senator WATT: You haven't. Okay, thank you. Very briefly on lockdowns, this year's federal budget included a range of assumptions on the frequency and length of lockdowns that were informed by advice from the Department of Health. Has the department provided any updated advice to Treasury or other departments on the likelihood, frequency, length or severity of lockdowns?

Dr Murphy : Not recently, but as I think the Prime Minister has indicated, there is a significant body of work being undertaken by the Doherty institute modelling with the delta strain what is likely to happen, including the impact of vaccination. That will be advice that all governments will look at when it's completed in coming weeks, but there hasn't been any specific advice to update other than the medical advice on the current situations in New South Wales, Victoria and South Australia, which have guided government decisions in relation to financial support.

Senator WATT: But it would be fair to assume—

CHAIR: Sorry, Senator Watt, can I just jump in. On the Doherty stuff, is the intention that it is going to be released in full?

Dr Murphy : The intention is that it will be released.

CHAIR: In full? The full work?

Dr Murphy : That is my understanding. Obviously, it is a decision for government, and national cabinet will be involved in that process, but my understanding is that the Prime Minister's intention is to release the information.

CHAIR: Sorry, Senator Watt. We've only got five minutes left, so I might have to do a quick check around, so if you could finish up.

Senator WATT: Sure. Leaving aside the work the Doherty institute is doing at the moment, has the department or, to your knowledge, ATAGI ever modelled the vaccination rate that would be required to avoid lockdowns? Obviously, we're now in a different world, and the Doherty institute is doing new work, but is that something the department or ATAGI has ever looked at previously?

Dr Murphy : Doherty did do some preliminary work in relation to the earlier strains, but, now that delta is the current strain, that is the current work that is being undertaken because that's the relevant work to the situation in this country at the moment. There is no relevant pre-existing modelling that would inform decisions about vaccination rates, but it's very clear that the Doherty modelling now is aimed to determine vaccination rates, both globally and for particularly vulnerable groups, that might be required to enable the next steps in the transition in our response in the coming out.

Senator WATT: What did the department previously advise government was required in terms of vaccination rates to avoid lockdown?

Dr Murphy : The previous advice to government was that the highest priority was to vaccinate those vulnerable from severe disease. That was the initial target. That was to be achieved by around this time, and we're very much on the path to achieving that. The next piece of advice was to offer every Australian vaccination by the end of this year, which seemed feasible, then, depending on the epidemiology evolving, modelling would be done to determine the ideal vaccination rate. That's the modelling that's being done now. It has to be done relevant to the strain that is circulating. So we don't have that information at the moment.

CHAIR: Senator Siewert, you have the last five minutes. Ms Blewitt is obviously chasing up that other answer for me. I'll follow that up.

Senator SIEWERT: Is there any consideration being given to reducing the movement of disability workers in congregate care in the same way as there has been consideration around residential care and workers moving between facilities? Is the same thing now being considered for disabled people in congregate care?

Mr Mulhall : I understand your question to be: 'Has there been any consideration to reducing the mobility of the disability workers?'

Senator SIEWERT: Yes.

Mr Mulhall : No is the answer to that question. I'm willing to look at it. Our efforts have been very much focused on vaccination rates. For disability workers, we're at 50.9 per cent at first dose. Our efforts have been on that.

Senator SIEWERT: I've got that information. How many disabled people in congregate care have had their first and second doses?

Mr Mulhall : For NDIS participants in disability accommodation, we have 22,285 we're talking of—

Senator SIEWERT: What percentage is that?

Mr Mulhall : We've had 53.8 per cent at first dose and 27.1 per cent fully vaccinated, two doses.

Senator SIEWERT: Could you take it on notice to provide a state breakdown for those figures?

Mr Mulhall : I am able to do that, yes.

Senator SIEWERT: Thank you. Do you have the figures for disabled people across the disabled population?

Mr Mulhall : I can partly answer that question. We are working on the broader definition of the disability cohort. For all NDIS participants, which includes 1b by definition, we're looking at in the order of 254,000 people. Currently we have 33 per cent with at least one dose and 14.7 per cent with both doses. But, as you appreciate, that is NDIS participants, and the sector is much broader than that. We've tried to enumerate that.

Senator SIEWERT: You foresaw my next question.

Mr Mulhall : We're continuing to put a definition around that.

Senator SIEWERT: You're just working on a definition? You don't actually know what proportion of disabled Australians have received a first or second dose?

Mr Mulhall : For the purposes of the task force, we're working on hard data sets. For the information I've given you, for example, the NDIS participants in disability accommodation—we know who they are with some high degree of confidence. We've now matched that against the Australian Immunisation Register, so with authority I can give you that information.

Senator SIEWERT: Is the information you gave me about congregate care more broadly or is it for those in congregate care with an NDIS package?

Mr Mulhall : They're in congregate care with an NDIS package, yes. They are recognised NDIS participants.

Senator SIEWERT: Am I correct in my understanding that, for people in care who don't have an NDIS package, you don't know how many have been vaccinated?

Mr Mulhall : No, that's not quite the case. I'm very happy to lay out to you, on notice, what we're working on, but in broad terms we have NDIS participants in disability accommodation, we have NDIS participants in residential aged care—and all of those sites have been visited—and we then have a small group, around 4½ thousand, who are funded in schemes by the states and territories, so we're working to give hard data against that. We know the number, but matching that against the Immunisation Register or other data sources—we're working through now to be able to give hard data on that. We've then got the broader participants within the National Disability Insurance Scheme—the 254,000 I spoke of. But then more broadly than that again is those who are covered by workers compensation and other schemes who, depending on definition, might be disabled or might not be. I'm trying to get a better understanding of that.

CHAIR: Senator Siewert, it's 1.45. I think you will have to put—

Senator SIEWERT: Can I put one on notice?

CHAIR: Yes, of course.

Senator SIEWERT: In terms of—

CHAIR: Like right now?

Senator SIEWERT: I mean now.

CHAIR: Okay. Make it snappy.

Senator SIEWERT: Following that thread of conversations, you've just mentioned the number of people that are on other schemes. There are a number of disabled Australians who don't have that source of funding. They don't have funding. How are you identifying them and getting an idea of the picture of those vulnerable Australians who have been vaccinated?

CHAIR: You can take that on notice, Mr Mulhall. Ms Blewitt, thank you for chasing that down for Senator Patrick.

Ms Blewitt : In relation to the question earlier about the recent delivery of Pfizer: this week we've received a million doses. That's been received in three points. There were 800K in Sydney—that's where it landed—100K in Perth and 100K in Melbourne, and then that's obviously distributed across the different channels according to General Frewen's plan.

CHAIR: Did he ask for the two weeks?

Senator PATRICK: I did—the previous week as well.

Ms Blewitt : I think it was a similar number, but I'll get that for you, definitely.

CHAIR: If you could. We will get that on notice for you, Senator Patrick. I thank everyone very much for their time today. I acknowledge it's exceptionally busy for you. We do appreciate it. That concludes today's hearing. Please provide answers to questions taken on notice by 6 August.

Committee adjourned at 13:47