Why the coronavirus vaccine rollout has been an abject failure

Under unfriendly questioning from Kate Eastman, the counsel assisting the royal commission into neglect of people with disability, the proposition had seemed to be self-evident, whether as a description of efforts to secure vaccines, to decide priorities in distributing them, to organising the logistics of doing so, or in giving information about it.

The vaccine rollout is a big political problem for government, the more so after the Prime Minister, Scott Morrison, assured Australians they were in the front of the queue for immunisation against the worst effects of COVID-19. While the size of the problem for the government may decline if and when Australia gets new supplies by the end of the year, it would seem very unlikely that anyone is ever going to describe the operation as a success.

But it's worth remembering that there's a strong political constituency, particularly in the Coalition, for saying that the public service, long in exile as political or policy advisers, cannot even manage things, or implement decisions anymore. That could be used as a staging point for suggesting that if there is another pandemic, the whole problem, including the organisation and management of another vaccination program, should be handed out to the private sector.

Indeed, most of the most serious problems have come from political decisions, some made in the face of medical advice, but not bravely repudiated, and from the serious failures caused by an outsourcing decision that could be justified in advance only on ideological grounds. In arrears, it was also a stupid decision, because the outside contractors were neither up to the jobs, nor agile enough to deal with unexpected problems, not least of supply. And it looks very much as if the private sector contractors are the ones primarily responsible for the balls-ups caused by the nomination of only limited numbers of medical practices for supplies, and the poor performances in coping with aged care homes, aged folk in the community, and the badly administered scheme of vaccinating health care workers, disability workers and people with disabilities.

The poor performance came not only from the arrangements organised by the untrained private-sector substitute for a public sector workforce, but from a host of consultants, including the Coalition's usual favourite cronies, advising the government what to do. Alas, it is going to be very difficult for quite some time to describe just how either of these groups let down the public, and incidentally the government, even as they trousered hundreds of millions from the public purse. This is because the terms of the relevant contracts have not been disclosed, nor were they awarded by public tender. Consultancy reports, many no doubt crafted to say what ministers wanted them to say, are described not only as commercial-in-confidence, but as being cabinet documents, perhaps as a part of the new self-serving convention that any meeting at which the prime minister is present involves a cabinet committee of at least one. This is a new system by which information and advice used in government decision-making processes is not independent, professional, transparent or accountable, even in arrears.

It is true that Ms Edwards was an attractive target for the royal commission. If one reads the early statements promising a fast rollout of the vaccine, first to the 1A category (such as health workers, cops, and folk in residential homes) and 1B (including those over 70 and younger folk with medical conditions) a clear public impression was given that disabled people in residential homes, and those with serious disabilities, were either 1A or 1B, perhaps both. That also seemed to be the intention, until it had to face supply shortages, logistic problems and some failure to realise that dealing with folk in four-bedroom homes was a bigger and more complex task than a large aged-persons home.

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Ms Edwards made a decision that people with disabilities would have to join another line, one perhaps still in the 1 category but not one being processed as quickly as aged people. The aged were the first priority because the evidence was unequivocal that age was the greatest single factor for Covid vulnerability. Disabled people, like people with auto-immune conditions and diabetes, were also a priority, but, on the evidence, not at as high a risk as the old.

Her decision was defensible - though the fact that it was not publicised was not. She was less than straightforward in conceding that pushing some people to the front of the line necessarily meant that those in other queues had to wait longer. But it was a bit over the top for it to be suggested that she had committed an unlawful act of discrimination in treating people with disabilities less favourably than another group - people in aged persons homes. First, people with disabilities in residential care (most of whom are under 50) are being treated more favourably than, say, people without disabilities under the age of 50: they are being treated in proportion to relative risk.

The real problem is not discrimination but bad organisation, aggravated as ever by overblown marketing by Scotty from Marketing. By rights all people with disabilities - indeed all people in the 1A and 1B class - should have been vaccinated by now. But many in this class will not get their first vaccine before July (at least three months later than promised) and the second dose may take until September. And that is only of the cohort who want vaccinations, or the ones on offer.

By way of masking these delays, politicians have opened fresh queues of even lower priority - people over the age of 50 - even as they are failing to do all of the work necessary to complete the higher priority task. What they are doing might be defensible if one could blame the more worthy classes for lack of initiative in getting themselves dosed. After all, one can now go to one's doctor - assuming she has not used up her mediocre ration - or to a mass vaccination facility. But leaving it to them ignores the fact that we - that is to say the less vulnerable part of the population - are at higher risk while a substantial proportion of the high-risk cases are not protected. And queues of the more fit and less vulnerable are pushing worthier cases out of the queue, and using up what is still in scarce supply.

Scott Morrison has repeatedly reiterated that all decisions in relation to coronavirus public health measures have been taken in accordance with medical advice. But the advice itself has frequently been considerably less than transparent, even as he has had medical officials standing alongside him, giving every appearance of having crafted his words and drafted his decisions.

The formal advice coming from his department and his chief medical officers has never been merely about the "facts" and a range of medical and epidemiological opinion as to what government should do. It involves having a weather eye out for what government wants to do, and what it most definitely does not want to do. It considers what is practically feasible - an assessment that involves an assessment of the political temperature and the personalities of relevant ministers, premiers and chief ministers. It involves a lot of intuition about what the government would most prefer to hear. The officials must also take into account, and be very loyal to, things that the Prime Minister has said in his repeated pronouncements, announcements and denouncements. The distillation of all of this might be the best the medicos can hope for, but it cannot be called the best detached judgment of what is best for the whole population.

Moreover, government has the capacity to shop around for the advice it wants to hear, and is doing so all of the time. It is also verballing its officials, or forcing them to verbal themselves when the government has adopted a temporary or permanent position on matters such as lockdowns, state border closures, international border closures, or banning flights from particular areas, such as India. This does not mean that politicians are necessarily making such decisions in bad faith. No doubt they are trying their best as they weigh and measure medical and political considerations.

The Morrison system of government does not permit dissenting voices, before or after the decision. Even from the experts whose advice they claim to follow.

Officials must toe the line. Or perhaps resign, if with certainty that the politicians and more senior bureaucrats will vilify you, and misrepresent the circumstances to make you the bad guy.

A good deal of the advice is coming from people with no particular medical backgrounds, including people who tend to think that running a pandemic is much the same as sailing a battleship or running a fish and chip shop. Not all of their advice is good; it is rarely disinterested. Often it is not able to be tested or contested by experts.

Morrison is greatly given to accusing any politician who disagrees with him of "playing politics". Yet he scarcely makes a decision, even on complex medical and epidemiological issues, without carefully considering the political ins-and-outs, political advantage for himself, and ways of manipulating the situation so as to put the other side at a disadvantage. He is a politician, after all.

Many of the ministers and not a few of their minders have backgrounds and further ambitions in the consultancies among whom they are distributing millions of dollars. One does not have to suggest that these contracts, like many defence contracts, offer future prospects to those doling out the public cash. It is, rather, that the buyers have roughly the same mindsets as the sellers, including the notion that a person who can advise on a gas industry matter one day, can the next give advice about the reorganisation of a department, or the best way of managing the welfare system.

And even the medical advisers must be silent where a now inconvenient decision has been overridden by political arse-covering. In Ms Edwards' evidence at the royal commission on Monday, for example, she was asked how another senior official had, on March 4, promised a consultative group that a "final implementation plan" for vaccinating people with disabilities in residential care was being finalised and would be available next week. The plan has yet to emerge; meanwhile, people with disabilities find themselves in the slow lane.

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Conceding on Monday that people in the sector had been waiting three months for vaccinations, Ms Edwards said that someone had decided that some of the relevant documents that might explain why were now regarded as cabinet documents, and thus unavailable to the royal commission.

One probably ought to assume that nearly everyone involved - perhaps even the consultants - are doing their best in novel circumstances without a clear road map. The virus has only been around for 18 months, and we are still learning new things about it and the way it spreads. Honest minds differed, here as well as overseas, about strategies of containing the virus. While some of our strategies and tactics were all over the shop, Australia was remarkably successful in holding down Covid incidence and deaths. The various vaccines are less than a year old, and it was not at first clear which were going to be the best. Governments were let down by suppliers and EU politics in securing supplies. Given the problems confronting our neighbours, and even the EU, it has been hard to insist on our priority, even if it is vitally important that we complete the vaccination task as soon as possible.

Even now, it seems likely that some of the government's secrecy and dissembling about supplies and an agonisingly slow vaccination rate has been supply problems with Astra-Zeneca from the Commonwealth Serum Laboratories. No doubt someone has thought that being frank with the public might cause despondency and alarm, or, more likely, fresh outbursts of popular cynicism about the reliability of Morrison's continual announcements, reannouncements, and restatements.

Morrison might deserve some credit for his preparedness to completely abandon mainstream parts of his faith about debt, deficit and John Maynard Keynes. He and the Treasurer can take some credit for the strength of the economic recovery. But so far as fighting the virus is concerned, Morrison's worst enemy has been his own mouth, and his track record for over-promising and under-delivering.

That an alarmingly high proportion of the population are now hesitant about getting vaccinations, now, or would prefer to wait until towards the end of the year when they hope to have some choice about the vaccine they get, is in part a reaction to this dud salesmanship. He may be Scotty from Marketing - ever more concerned with flim-flam than substance. But it's a marketing myth - promoted by himself - that he was ever much good at it.