2.1
The Australian Government (government) was poorly prepared from the outset of the pandemic and failed to properly plan for the challenges that arose as the pandemic continued. This is evident in the mismanagement of Australia's international borders and quarantine arrangements; the lack of readiness of the National Medical Stockpile to supply the personal protective equipment necessary for infection control; failure to protect already vulnerable Australians, including people in residential aged care, from the worst impacts of the pandemic; a haphazard and sluggish national rollout of COVID-19 vaccines; and failure to plan for the emergence of a new variant as public health restrictions eased in late 2021.
Readiness for a pandemic
2.2
In its first interim report, the committee noted deficiencies in the Australian Government's pre-pandemic planning.
2.3
The Australian National Audit Office (ANAO) found that not only was the government's pre-pandemic planning deficient, but departmental officials were aware of these deficiencies and failed to communicate this to ministers.
2.4
In a damning finding, the ANAO noted that the results of a pandemic 'stress test' conducted in 2018 by the newly established Department of Home Affairs had not been provided to the Minister for Home Affairs until a month into the COVID-19 pandemic. The stress test apparently highlighted 'significant concerns not being, or not able to be, addressed'. Further, on 1 February 2020 the Secretary of the Department of Home Affairs wrote to the Prime Minister and Minister for Home Affairs to advise that Australia's whole-of-government civil contingency planning was 'outdated and not fit for purpose.'
2.5
Yet, on 5 May 2020, the Secretary of the Department of Home Affairs described the extensive 'hazard-agnostic planning' and civil contingency planning the department had undertaken since its establishment and claimed this planning had enabled the department to rapidly respond to the COVID-19 outbreak.
2.6
The ANAO revealed that the Department of Home Affairs and the Department of Health began planning for 'an extreme national catastrophic pandemic disaster' on 2 February 2020, the day after the Australian Government introduced its first travel restrictions.
2.7
The Australian Health Sector Emergency Response Plan for Novel Coronavirus (or COVID-19 Plan) was released in February 2020. It was less comprehensive than the 2019 Australian Health Management Plan for Pandemic Influenza from which it was adapted and, among other omissions, failed to take account of the different constitutional responsibilities of the Commonwealth and the states. The pandemic influenza plan also made no provision for mass quarantine and had identified difficulties associated with the voluntary isolation of ill travellers not requiring hospitalisation, noting, 'isolation of cases with mild symptoms may be difficult to enforce. No quarantine premises are available, and use of hotels is problematic.'
2.8
Similarly, the COVID-19 Plan made only limited reference to quarantining of repatriated nationals and approved foreign nationals. Consequently, the plan did not outline which level of government would be responsible for this. It appears that the authors had concluded international travel restrictions and mass quarantine would not be effective in responding to a pandemic. This was a critical downfall in planning for the pandemic response.
2.9
While the COVID-19 Plan was characterised by the Department of Health as a 'living document', it was not. The plan was not updated throughout the first 18 months of the pandemic, meaning information on governance and coordination set out in the plan was quickly outdated. The consequences of this were revealed in the results of a 'lessons learnt' exercise undertaken by the Department of the Prime Minister and Cabinet in mid-2020, which acknowledged breakdowns in coordination, information dissemination, and data sharing. It is inexcusable that those responsible for advising on and leading the government's response failed in this way.
2.10
The committee recommends that the Australian Government commit to resourcing and delivering whole-of-government pandemic preparedness exercises every two years, commencing 2024, on the scale of Exercise Sustain in 2008.
The management of Australia's international border
2.11
The committee has previously highlighted that the COVID-19 Plan did not contemplate the closure of international borders and the flow-on consequences of this.
2.12
It is clear that the key to containing the spread of COVID-19 in Australia during the early stages of the pandemic was management of the international border and quarantining of arrivals. However, the Australian Government was poorly prepared to manage the closure of its international border, and had made no plans for managing international arrivals.
2.13
When the government began introducing travel restrictions and mandatory self-isolation requirements from 1 February 2020 there was no blueprint for implementation of the restrictions, and it was unclear which level of government was responsible for monitoring compliance. There was a similar lack of clarity regarding the lines of operational responsibility for quarantine arrangements.
Quarantine
2.14
The Australian Government has a clear constitutional responsibility for incoming arrivals and quarantine. Quarantine proved to be a weak link in Australia's defences against COVID-19, and seeded major clusters of infections instead of protecting against them. Responsibility for this failure to plan for pandemic quarantine arrangements sits squarely with the Australian Government.
2.15
The Australian Government was caught flat-footed when it finally announced mandatory quarantine requirements for incoming travellers from 28 March 2020—ten days after the Australian Health Protection Principal Committee (AHPPC) recommended universal quarantine.
2.16
The whole-of-government submission to the committee suggested a seamless introduction of mandatory quarantine arrangements by state and territory governments, supported by the Commonwealth:
From 28 March 2020, further restrictions were imposed on the movement of incoming travellers. State and territory governments, supported by Commonwealth law enforcement agencies and the Australian Defence Force, implemented mandatory 14-day quarantine arrangements at designated facilities, including hotels for all international arrivals. This is enforceable under state and territory law.
2.17
What the submission did not describe is the surprise of state and territory leaders when they found the Australian Government had no plan to act on its constitutional responsibilities for quarantine. It did not acknowledge that there was a clear intention from the outset to rely on hotels for the mass quarantine of international arrivals and that arrangements to support this would need to be hastily cobbled together over a single weekend.
2.18
Travel restrictions imposed by the Australian Government during the initial phase of the response were delayed and inconsistent, with no clear lines of responsibility for quarantine arrangements.
2.19
The decision to rely on hotel quarantine and push responsibility for its implementation to the states and territories was a matter of political expediency rather than a considered policy response. In the absence of dedicated quarantine facilities, the potential to use hotels as quarantine facilities offered a quick, but ultimately flawed, solution.
2.20
The ANAO's summary of the steps that led to the use of hotels for quarantine confirms this:
On 26 March 2020 the CMO [Chief Medical Officer] emailed the Secretary of Home Affairs and the Australian Border Force (ABF) Commissioner noting a concern that the 'great majority of our new COVID-19 cases are still returned travellers' and stating he was 'seriously considering whether we should be formally quarantining ALL returned travellers'. The CMO also noted that: 'There must be a lot of empty airport hotels and we could take everyone straight to a designated hotel and keep them there for 2 weeks. States and Territories would have to provide the Health services to them'.
2.21
The ANAO reported that the CMO emailed the proposal to the AHPPC on 26 March 2020. The AHPPC met the same day and agreed to the proposal to quarantine returning travellers where they land. The next day, National Cabinet agreed to 14 days mandatory self-isolation for international arrivals at 'designated facilities (for example, a hotel)' from 11.59 pm on 28 March 2020.
2.22
Following the National Cabinet decision on 27 March 2020, states and territories were required to establish hotel quarantine arrangements at short notice. As Victoria's COVID-19 Hotel Quarantine Inquiry noted, this was a 'most unsatisfactory situation from which to develop such a complex and high-risk program':
The lack of a plan for mandatory mass quarantine meant that Victoria's Quarantine Program was conceived and implemented 'from scratch', to be operational within 36 hours, from concept to operation.
2.23
The report of the Western Australian Review of Hotel Quarantine Arrangements captures the complexity of the programs that states and territories were required to establish in such a short timeframe:
Quarantine remains a complex public health function, with strong program elements of logistics, security, compliance and risk management. It requires the highest levels of corporate and clinical governance, and continuous attention to fundamental IPC [infection, prevention and control] principles throughout the end-to-end process. It is government's responsibility, but requires private sector partnerships.
2.24
The Victorian inquiry noted that the ad hoc manner in which facilities were stood up could have been avoided had there been a set of nationally consistent principles to form the basis for jurisdictions to develop operating guidelines, plans for accommodating potentially infected people and better systems to support people in quarantine.
Cruise ships
2.25
In May 2019, less than a year before the pandemic, the Australian Government participated in another pandemic planning exercise specifically for disease containment on a cruise ship arriving in Sydney. Despite this exercise, and the known risks of infection containment on cruise ships, the AHPPC was still reviewing protocols for cruise ship arrivals in late February 2020. As a result, the Australian Government was woefully underprepared to manage the entry of cruise ships to Australia.
2.26
On 15 March 2020, the government banned all cruise ships entering Australia and made 'bespoke arrangements' to manage ships entering port that had departed before a certain date. However, the government's mismanagement of its direct responsibility for enforcement of those arrangements allowed for passengers to disembark from the Ruby Princess in Sydney on 19 March 2020, with disastrous consequences for the nation. Over 120 passengers and crew (17.5 per cent of those onboard) were later found to have contracted
COVID-19, leading to 28 deaths and what was at the time Australia's worst COVID-19 cluster.
2.27
As detailed previously by this committee, the Australian Government has not provided a satisfactory explanation for the breakdowns that led to the Ruby Princess debacle. The Australian Border Force, the Department of Agriculture, Water and the Environment, and the CMO all had responsibilities for managing cruise ship arrivals in Australia at the time. What is clear, however, is that critical steps required of federal agencies to plan for and manage cruise ship arrivals were ignored by officials. As concluded previously by this committee:
The revelations of the government's laissez faire approach to its own policy leaves open the possibility of fundamental flaws in the application of biosecurity procedures at every port in Australia.
National Medical Stockpile and personal protective equipment
2.28
The National Medical Stockpile (NMS) is a strategic reserve of medical supplies and equipment for use during a national response to a public health emergency. However, the NMS was critically under-resourced for the
COVID-19 response. Prior to the onset of the pandemic, the government ignored warnings of the need to build reserves of personal protective equipment (PPE).
2.29
In December 2020, the committee concluded:
The government should have acted on warnings received prior to the pandemic about the inadequacy of strategic stores in the NMS. Instead, crisis purchasing and large outlays of public funds were spent trying to locate and secure adequate supplies for the stockpile.
2.30
In May 2021, the ANAO found that there had been an 'absence of risk-based planning and systems that sufficiently considered the likely ways in which the NMS would be needed in a pandemic' at the NMS. Further, the ANAO found that 'risks to effective deployment in a pandemic of any magnitude were not sufficiently considered in the years preceding the COVID-19 response'.
2.31
In May 2020 the NMS did not have a current strategic plan, and while its previous strategic plan (2015–2019) had identified development of a deployment plan as a priority before 2020, one had not been finalised.
2.32
Fewer than half the requests (46 per cent) for PPE from the National Medical Stockpile by the aged care sector were approved from the onset of the
COVID-19 pandemic until mid-August 2020. The Royal Australian College of General Practitioners reported that general practitioners (GPs) had resorted to unsafely reusing PPE or purchasing equipment on the open market at inflated rates.
2.33
To the detriment of Australia's health system, the government has continued to underperform in its administration of the NMS at key stages of the pandemic. While the government has published advice on the critical importance of healthcare workers using PPE to manage COVID-19 infection, the reality is the government did not always ensure workers in high-risk environments had adequate access to PPE. The shortages which were evident across critical health care facilities were also present for the wider community, leading to fear and uncertainty, with hoarding and price gouging further distorting availability of PPE when supplies were low.
2.34
The committee recommends that the Australian Government consider appropriate future arrangements to enhance the performance of the National Medical Stockpile, including whether it should be housed and managed by an Australian Centre for Disease Control.
2.35
The committee recommends that the Australian Government take action to rebuild Australia’s diminished sovereign manufacturing capability and develop strategies for emergency redirection of key manufacturing resources to pandemic preparedness and response.
Aged care
2.36
The Australian Government has funding and regulatory responsibility for the aged care sector. It also has clear evidence of the crisis in the sector, and recommendations on how to fix it, including from the Royal Commission into Aged Care Quality and Safety (Royal Commission). However, the Australian Government has ignored warnings about neglect in the system. It should have anticipated the risk and impact of COVID-19 in residential care facilities, and it should have had a plan to protect residents and the staff that care for them.
2.37
In September 2020 the Royal Commission delivered a special report on aged care and COVID-19. The commissioners reported that never before had the aged care sector faced a challenge like COVID-19. A disproportionate number of deaths from COVID-19 had occurred in residential aged care facilities, and the already under resourced and overworked aged care workforce was now traumatised.
2.38
Among the recommendations made for immediate action was the publication of a national aged care plan for COVID-19, informed by the establishment of a national aged care advisory body. It took until December 2021 for the government to convene a meeting of an advisory body, by which time the virus had had a devastating impact on aged care residents and their families and staff. A COVID-19 Aged Care plan '7th edition' was published by the government on 30 November 2021. Under Freedom of Information disclosures it is clear that the government engaged in a revision of history by claiming the plan as a 7th edition when no previous editions of the plan existed.
2.39
The Royal Commission also recommended that an aged care plan should establish protocols between the Australian Government and states and territories. It observed that lack of clarity of roles added to complexity and cited the 'dilemma' faced by senior facility managers when a dispute developed between Australian Government officials and state government officials about the transfer to hospital of residents with COVID-19. The incident is described as an impasse that led to a high degree of frustration.
2.40
In this case—and in many other instances—the relationship between the Australian Government and the states and territories has been unclear, mismanaged, or absent. This has hindered effective planning and responsiveness and led to poorer outcomes for the community.
2.41
In its first interim report, the committee found that the Australian Government had failed to take responsibility for the crisis in the aged care sector. By 9 October 2020, 683 Australians had died from COVID-19 in aged care facilities, accounting for 3 out of every 4 pandemic-related deaths in Australia at the time. Yet the government failed to learn lessons from early outcomes, and Australia has continued to experience extremely poor outcomes in residential aged care during the pandemic. The government's failure to take responsibility and deliver better outcomes is examined in Chapter 3.
Vaccine supply
2.42
Securing vaccines for Australia is solely a Commonwealth Government responsibility. It is the foundation of a successful rollout; without enough vaccines, even the most sophisticated rollout strategy will fail.
2.43
Government announcements showed promise in the second quarter of 2020, when Australia was among the first to order supplies of AstraZeneca and the government trumpeted local manufacturing capacity of both AstraZeneca and the University of Queensland vaccine that was in local development. These early announcements appear to have been made for political expediency and did not translate into adequate supply in early 2021.
2.44
By December 2020, this committee had already expressed concern at the lack of urgency by the government to secure vaccine deals and its seeming lack of transparency:
The Australian Government has lagged in securing vaccine deals and needs to do more to catch up. It also overstated its progress towards securing access to a vaccine in August when it prematurely announced a deal with the pharmaceutical company AstraZeneca.
2.45
The committee also called on the government to secure as many deals as possible to ensure a timely and sufficiently large supply of vaccines.
2.46
However, within months of initial announcements, the government's rollout was already in trouble. Trials of the University of Queensland vaccine had to be scrapped and reports emerged that AstraZeneca had reported results which combined data from separate trials, casting doubt on the results.
2.47
Despite issues arising during trials that were beyond the government's control, it was the government's responsibility to plan for the possibility of any of the vaccine candidates encountering unforeseen obstacles. The government should have, and was advised to, diversify its supply orders to include a wider range of vaccines.
2.48
Australia was still experiencing vaccine shortages more than half a year later, in the third quarter of 2021, during a large outbreak of the Delta variant.
2.49
The government did not heed warnings against a concentrated risk strategy, instead opting to rely heavily on only one vaccine, AstraZeneca. The weakness of this supply strategy was laid bare when a rare blood-clotting complication from the AstraZeneca vaccine was identified once the rollout was underway, causing hesitancy and a population-wide preference for the Pfizer vaccine, ordering of which had been bungled by the government.
Bungled Pfizer deal
2.50
A surge in demand for Pfizer vaccines could not be met. The situation was not helped by a pervasive lack of transparency from the government on the actual number of Pfizer doses available. By September 2021, media outlets were reporting reductions in state and territory vaccine allocations. These reports appeared to come from National Cabinet leaks, but the situation was never clarified for the Australian public.
2.51
Documents released under freedom of information legislation show that discussions between Pfizer and the Australian Government began on 26 June 2020. This was followed by an approach from Pfizer to the Minister for Health on 30 June 2020, in which the pharmaceutical company wanted to discuss a deal for vaccines. Case numbers were doubling in Victoria at the time, however, the contract was not signed for another four months.
2.52
The government has consistently said that decisions about how many vaccine agreements to pursue, and with which vaccine developers, were based on expert medical advice.
2.53
Yet, members of the government's own vaccine advisory group, the Science and Industry Technical Advisory Group, state that their advice was based on ensuring adequate quantities of all vaccines available:
We were presented with options and we gave our views on them. We did not say to them prospectively, we think this is what you need to do… Across all of the vaccines, we said get as much as you can.
All our eggs in one basket
2.54
Supply agreements with vaccine manufacturers were by necessity secured before post-market safety or efficacy analysis could be performed, in mid-2020. The government could not have foreseen a rare but serious issue arising with the AstraZeneca vaccine. But the Australian Government should have had enough foresight to put a Plan B in place.
2.55
Instead, the lack of vaccine diversity in the early stage of the rollout, when the complication associated with AstraZeneca influenced public perceptions of safety, threw the program into disarray.
2.56
This contributed to relatively low vaccine uptake three months into the rollout, leaving NSW, Victoria and the ACT underprepared for outbreaks in mid-2021.
2.57
Lack of supply of Pfizer vaccines led to states and territories competing for stock. Nothing which transpired with the rollout in 2021 could be described as an equitable, methodical distribution by a responsible government. While NSW had extra doses prioritised for its outbreak, other states were left insufficient supplies to contend with.
2.58
The need for the government to scramble to reach agreements with Poland and the United Kingdom for access to their surplus Pfizer stock was created by its earlier failures.
2.59
This was not a situation a developed country should have found itself in, with vaccine contracts within ready reach.
2.60
The vaccine supply bungles were compounded by the Morrison Government's decision that Moderna vaccines weren't needed because Pfizer could provide all the mRNA doses we needed.
2.61
According to evidence to this committee, as late as 20 April 2021 the Morrison Government hadn't even asked Moderna if it could supply doses.
2.62
On 12 May 2021, when Moderna announced its first supply agreement with Australia, the company already had supply agreements with the United States, Israel, the Philippines, Japan, the European Union, Canada, Qatar, Taiwan, Singapore, Switzerland, the United Kingdom, and Korea.
2.63
Late in 2021, when Australia's vaccine supply woes finally began to ease and the national vaccination rate climbed, it became apparent that booster doses would be needed due to the waning protection offered by primary doses of Pfizer, AstraZeneca, and Moderna.
2.64
The interval for booster doses changed considerably as advice from the Australian Technical Advisory Group on Immunisation (ATAGI) evolved. Initially, booster doses were recommended six months after the primary vaccine course; this changed to five months in early December 2021; four months from 4 January 2022; and three months from 31 January 2022.
2.65
While the shift in ATAGI's advice reflected evolving medical understanding, the advice was also informed, in part, by vaccine stock availability, and was therefore constrained by the government's failure to take responsibility for ensuring an adequate and early supply of vaccines. This leaves open the possibility that the initial eligibility interval of six months, which left older Australians vulnerable, was only reduced once sufficient stock could be guaranteed.
Vaccine rollout
2.66
In January 2021, the Australian Government released a five-step national vaccine rollout strategy. The rollout strategy was launched on 21 February 2021 and established priority vaccine recipient groups for each phase, as detailed below. It did not set time-bound targets:
Phase 1a: quarantine and border workers; frontline health care worker sub-groups for prioritisation; aged care and disability care staff; aged care and disability care residents;
Phase 1b: elderly adults aged 80 years and over; elderly adults aged
70–79 years; other health care workers; Aboriginal and Torres Strait Islander people over 55 years; younger adults with an underlying medical condition, including those with a disability; critical and high-risk workers, including defence, police, fire, emergency services, and meat processing;
Phase 2a: adults aged 50–69 years; Aboriginal and Torres Strait Islander people 18–54; other critical and high risk workers;
Phase 2b: general unvaccinated population; catch up from previous categories; and
Phase 3: general population under 18 years, subject to health advice.
2.67
The rollout strategy was accompanied by a series of rapid-fire announcements, setting self-imposed government targets for the rollout of COVID-19 vaccinations across the country. These targets were repeatedly revised before being missed altogether.
'Four million by April'
2.68
In January 2021, the Prime Minister announced four million Australians would be vaccinated by the end of March. Mr Morrison subsequently stepped back from this target, claiming it had been 'subject to the progress of the rollout and the events that we encounter along the way'. Separately, he attributed the missed target to overseas supply issues.
2.69
By the end of March 2021, fewer than 600 000 doses of a vaccine had been administered—a shortfall of over 3.4 million.
'Fully vaccinated' by October 2021
2.70
On 28 December 2020, Minister for Health and Aged Care, the Hon Greg Hunt MP, announced all Australians would be 'fully vaccinated' by October 2021.
2.71
On 1 February 2021, the Prime Minister qualified the target set by Mr Hunt: 'our aim is to offer all Australians the opportunity to be vaccinated by October'. A month later, he announced Australia was on track for full vaccination by October 2021.
2.72
The Secretary of the Department of the Prime Minister and Cabinet, Mr Phil Gaetjens, told the committee on 9 March 2021 he understood 'fully vaccinated' in the context of the government target consisted of two doses of a vaccine.
2.73
On 11 March 2021, the Secretary of the Department of Health, Dr Brendan Murphy, walked back the government's firm October deadline of full vaccination, telling the committee the aim was now to 'offer everyone a vaccine by the end of October'. Dr Murphy conceded some Australians would only have access to a first dose by this deadline, but argued the shift from the original target of full coverage was only a 'semantic difference'.
2.74
On 29 March 2021, Mr Hunt casually revised his October deadline, stating, 'we remain on track for all the first doses before the end of October'.
2.75
On 2 November 2021, 89 per cent of Australians over 16 years had received a first dose, with 78 per cent having received both doses of a vaccine. This reached 80 per cent four days later.
2.76
On 6 November 2021, the Prime Minister publicly claimed success, despite the missed targets.
People with a disability
2.77
In March 2020, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability issued a Statement of Concern, calling on Australian governments to ensure future emergency planning and responses include a specific strategy to provide appropriate guidance, support, and funding to meet the particular needs and requirements of people with disability.
2.78
Many countries vaccinated people with a disability first. This was not the case in Australia where the government failed to implement strategies which would protect this vulnerable group as soon as vaccines became available.
2.79
This failure to protect extended to the most vulnerable people with a disability, those in care facilities. Despite being prioritised in phase 1a of the national vaccine rollout strategy, many disability care residents were left unvaccinated and had to make their own arrangements to go to a GP for the vaccine. By June 2021 (more than three months after the rollout began), only 355 people living in disability residential facilities across Australia had been vaccinated.
2.80
In February 2022, the Royal Commission issued a Statement of Ongoing Concern that people with disability are still not being appropriately prioritised during this phase of the pandemic in relation to health care, disability support, and the vaccine and booster rollout.
2.81
It is unacceptable that emergency planning for, and government responses to, the needs of people with a disability were initially so poor, and failed to improve over the course of the pandemic.
Omicron wave: Letting it rip
2.82
In December 2021, the government pushed forward with plans to ease public health restrictions as the Prime Minister urged state and territory governments to 'step back', and 'put Australians back in charge of their own lives'. He even urged Australians to take 'personal responsibility' for their health. But the government failed to adequately plan or prepare for what this would entail.
2.83
Almost two years into the pandemic, the government was wholly unprepared for the widespread transmission of the highly infectious Omicron variant, leaving Australians further exposed to the social, health, and economic impacts of the virus.
2.84
When Omicron was first detected in Australia on 28 November 2021 there were over 14 000 active COVID-19 cases, over 500 people in hospital with COVID-19, over 200 000 total cases, and nearly 2000 deaths.
2.85
On 21 December 2021, the Prime Minister downplayed modelling from the Doherty Institute which anticipated a significant increase in daily COVID-19 infections over the following months. Within three weeks, Australia had over 600 000 active COVID-19 cases and on 10 January 2022 it recorded over 90 000 new cases in a single day. The Australian Government denied it had 'let Omicron rip'.
2.86
The situation continued to deteriorate through January 2022 as active cases reached over 765 000 and daily cases peaked at over 155 000. In the first two months of 2022, the total number of COVID-19 cases in Australia had increased seven-fold to over 2.8 million. Deaths more-than doubled to 5171. Regrettably, health experts maintained that these figures could have been reduced through a more effective response.
Rapid testing: A failure to plan
2.87
Until early 2022, the national response to COVID-19 relied on a testing regime built exclusively on the so-called 'gold standard' quantitative reverse transcriptase-polymerase chain reaction (RT-PCR or PCR). However the testing regime collapsed in response to the easing of public health restrictions, widespread transmission of the Omicron variant, and pre-travel testing requirements in some states—which accounted for up to 20–25 per cent of peak demand in some jurisdictions over the Christmas 2021 period.
2.88
Australians were forced to queue for hours to be tested for COVID-19, with many waiting days to find out if they were infected. These delays kept families apart over the holidays, forced individuals into needless isolation, and compounded critical workforce shortages that added to the pressures faced by businesses.
2.89
Australia had two years to prepare the testing system for high-level community transmission, through, for example, ensuring rapid COVID-19 tests were approved, stockpiled, and integrated into the national testing regime. But this was not done in time.
2.90
Indeed, evidence to the committee suggests the government undertook limited scenario planning to prepare the system to respond to a variant of higher transmissibility or widespread infections following an easing of public health restrictions. For example, Ms Alison Frame, Deputy Secretary at the Department of Prime Minister and Cabinet, acknowledged to the committee that the Government was aware that rapid antigen tests (RATs) would play 'an increasing role' in the pandemic response, but conceded there had been few preparations for their rollout and little planning in the event of a collapse of the PCR testing system.
2.91
Tragically, these pressures had been foreseen. For example, Professor Deborah Williamson, deputy director of the Microbiological Diagnostic Unit at the Doherty Institute, warned as far back as August 2021:
As we transition through the pandemic and we start to think about opening up, there are very real questions of whether that PCR capacity will still meet demand for testing, it seems unlikely it will.
2.92
Indeed, experts had long been calling for RATs to be integrated into the national testing regime to mitigate the impact of widespread transmission on the PCR-based system. For example, Dr Ian Norton, a former head of the World Health Organisation's emergency medical team, advocated in late 2020 that RATs be introduced in Australia as an added layer of testing. In September 2021, Professor Mary-Louise McLaws, an infectious diseases expert, also discussed RATs with the committee, highlighting their importance for when Australians would be 'living with' COVID-19.
2.93
Separately, Dr Norton claimed he had called on political leaders and health officials to secure large supplies of RATs. He stated:
We were watching other countries stocking up on RAT tests and wondering why on earth we were not getting ready in case that happens here.
2.94
Mr Dean Whiting, Chief Executive of Pathology Technology Australia (the peak body representing manufacturers and importers of rapid antigen tests) claimed to have regularly met 'many politicians' since October 2020 to press for the widespread adoption of RATs in Australia, with little progress. Manufacturers of RATs also publicly expressed frustration at what they perceived to be 'resistance' to the use of rapid testing in Australia. Even former Liberal Treasurer the Hon Joe Hockey weighed in, claiming it was 'like moving mountains' to get rapid tests accepted by the government. Separately, Mr Hockey described delayed RAT approvals in Australia as 'absurd'.
2.95
The government's own medical advisors also highlighted the advantages of RATs to the committee. In September 2021 Professor Paul Kelly, Chief Medical Officer at the Department of Health, claimed PCR tests were more appropriate when seeking to eradicate the disease, but acknowledged rapid tests were useful 'as we move into a time of living with COVID'.
2.96
Dr Brendan Murphy, Secretary at the Department of Health, also told the committee:
Now that we have community transmission and we're starting to transition to living with COVID [rapid antigen tests] are applicable, and we are pulling out all stops to get the regulatory approval done as quickly as possible. Then, national cabinet will consider their role in the reopening plan.
2.97
Despite rapid testing having been rolled out widely across other jurisdictions like the United States and the United Kingdom from late 2020, the Australian Government was slow to pave the way—or plan—for the broad introduction of RATs in Australia.
2.98
There was acknowledgement by the Communicable Diseases Network Australia of the potential role that RATs would play in certain high-risk settings as early as February 2021. In August 2021, the government began a trial deployment of RATs in Commonwealth-funded residential aged-care facilities in high-risk areas of New South Wales. As part of that trial, both Senator the Hon Richard Colbeck, Minister for Senior Australians and Aged Care Services, and the Hon Greg Hunt MP, Minister for Health and Aged Care, were briefed on the role of RATs for screening purposes. But little appears to have been done to pave the way for a broader rollout of rapid tests.
2.99
In September 2021, Adjunct Professor John Skerritt, Deputy Secretary of the Department of Health and head of the Therapeutic Goods Administration (TGA), informed the committee that legislative changes were underway that would allow RATs to be made available for home use from 1 November 2021. But until early 2022, legislation in some states still prohibited unsupervised at-home rapid COVID-19 testing.
2.100
When the PCR-based testing regime was overwhelmed in late 2021, the government began to turn to RATs to supplement the failing system. According to evidence provided to the committee, the government failed to place any orders for rapid testing kits until around 20 December 2021. The delay in securing supply contributed to nation-wide shortages of rapid testing kits throughout the holiday period that crippled businesses and disrupted critical supply chains, leaving supermarket shelves bare. This led to a food security crisis at a national level that highlighted vulnerabilities in our supply chains which could have been avoided.
2.101
Some retailers reportedly doubled their prices of rapid testing kits amid the surge in demand and supply shortages, prompting accusations of price-gouging. By January 2022, consumers were paying between $20 to $30 per test, as compared with wholesale prices of between $3.82 and $11.42 per test.
2.102
Moreover, systems had not been put in place at the federal, state, or territory levels to ensure the results from rapid antigen tests were recorded and referred to relevant health authorities.
2.103
On 24 January 2022, in a hurried response to escalating national outrage over the lack of access and affordability of RATs, the government introduced a concessional access programme to enable eligible concession card holders to collect up to 10 free RATs over a three-month period from participating pharmacies. But Pharmacy Guild of Australia president Trent Twomey warned the scheme would be significantly impacted by supply shortages and many pharmacists complained that they were having to carry costs associated with the scheme.
Health care system
2.104
As Omicron cases peaked in January 2022, Australia's health system was placed under severe pressure. Patient demand spiked and system capacity was constrained as health workers became sick or were required to isolate. Hospital staff ratios were stretched; non-urgent elective surgeries were postponed; GPs became overwhelmed; and ambulance services experienced significantly delayed response times. The pressure of the Omicron outbreak on the health system compounded existing pressures and risked the system's patient care capabilities.
2.105
Despite the Australian Government's assurances about the health system's preparedness and capability to meet demand during the pandemic, the experience during the Omicron outbreak showed that there was a real risk of the system failing under pandemic pressures.
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The January 2022 increase in Omicron cases resulted in a ten-fold increase in the number of patients admitted to hospital with COVID-19. The Australian College for Emergency Medicine said that many COVID-19 positive people presenting to emergency departments were 'requiring admission to hospital, many also—although requiring clinical assessment—are well enough to be discharged.' However, many people presenting to emergency departments were not aware of how to respond to a positive COVID-19 test, resulting in calls for a public information campaign.
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Hospitals in urban and regional areas experienced significant staff shortages to deal with the increased patient demand. In some cases, staff to patient ratios fell below mandated levels and staff reported having to make significant compromises in patient care; nursing shifts went unfilled, even as staff were recalled from their holiday leave; and some lower-risk patients were moved to hotels or private hospitals for treatment.
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In order to preserve hospital resources, several jurisdictions postponed non-urgent elective surgeries. This prompted concerns from surgeons about the health impacts on affected patients, particularly as elective surgery wait times had already increased during earlier phases of the pandemic in 2020–21. The government has no apparent plan to manage the backlog of elective surgeries, which will be a burden on individuals and the health system for some time.
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Hospital staff shortages were so acute that some hospitals were forced to plead with staff to take any extra shifts that they could, and even sought to employ staff from overseas. To address the 'enormous burden' on healthcare staff, the government has relied on unique workforce arrangements, including the redeployment of staff from the private hospitals and establishing a surge workforce of retired, part-time, and under-employed healthcare staff to backfill services.
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When the capacity in the system fell short, the Australian Government framed the shortcomings as due to Omicron being 'like dealing with a completely different virus' and that the variant had 'changed all the rules'. This was inconsistent with the government's lines-of-the-day and messaging to downplay within the community the impact of Omicron. At various times, the government stated it was 'not spooked' by Omicron, that states should not 'overreact' in their responses, and that Omicron was just a 'gear change and we have to push through.'
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In December 2021, health experts encouraged 'proportionate and measured application of public health levers' and 'tightening public health restrictions' to help control the community transmission of Omicron. However, the Prime Minister was reluctant to lead on these health measures and focused on the 'personal responsibility' of Australians during the outbreak:
If you feel uncomfortable about going out in other public spaces, well, you can choose to stay home, you can choose to wear a mask, you can choose many things to protect your own health, but they're your choices, and we have to be careful about imposing our choices on others.
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Evidence provided to the committee suggests that the Australian Government planned 'for a worst-case eventuality in the health system' but did not anticipate the 'extent of the transmissibility' of the Omicron variant. However this position is contrary to the views of some health experts, including University of New South Wales Sydney, epidemiologist Professor Raina MacIntyre, who said:
There was no planning. We knew there'd be a surge when restrictions were relaxed… To anyone who understands epidemic spread, it was 100% predictable there'd be this surge in cases.
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By not preparing the health system or taking early and proportionate action in responding to the highly infectious Omicron variant, Australia's plan for living with COVID-19 rested on the government's hope for a positive outcome rather than proper planning for a worst-case scenario. In the committee's view, this is a dire policy failure that left Australians unnecessarily exposed to the Omicron variant.
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COVID-19 continues to be a significant public health challenge. SARS-CoV-2 can evolve rapidly, and there is an ongoing risk of recurrent COVID-19 waves. Living with COVID-19 effectively in 2022 means it must be a national priority for the Australian Government to ensure Australia's health system is prepared for those demands.