Opinion | Covid Zero Is No Longer Working for Australia

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Edward Cliff and

Dr. Cliff is a hematology doctor in Melbourne, Australia. Dr. Fernandes is a palliative care doctor in Sydney. Both worked in Covid-19 wards at their hospitals.

Australia was, until recently, heralded for its effective suppression of Covid-19; through strict border closures, prolonged lockdowns and its fortune as a remote island continent, the country was able to avoid a large-scale outbreak. The Delta variant has, however, turned that success upside down.

Despite more than half of Australia’s 25 million inhabitants living under very harsh restrictions — including overnight curfews, travel limits of only about three miles from home and limits on outdoor daily exercise to a couple of hours — cases have soared to more than 1,400 a day, the most since the pandemic began. As authorities tighten restrictions, hospitals are reaching capacity with Covid-19 patients, and Australia’s delayed vaccination program is only beginning to gain momentum.

Pre-Delta, Australia’s aggressive lockdowns quashed Covid-19 cases and allowed for the return to near-normal life from around December 2020 to May 2021. But this lulled the country into a false sense of security, and only 8 percent of eligible Australians were fully vaccinated by July 2021. Vaccination has progressed in recent weeks, likely thanks to a growing supply of the Pfizer vaccine and increased motivation to get out from under restrictions. Now 39 percent of eligible Australians are fully vaccinated, and 64 percent have had at least one dose.

The country’s slow start to vaccinations stemmed from its inability to produce mRNA vaccines locally and its struggle to procure other vaccine options, leaving it dependent on the AstraZeneca vaccine as its vaccination program’s backbone. When rare cases of blood clots were tied to the AstraZeneca vaccine, the country was unable to pivot. Though well intentioned, Australia’s scientific advisory group for immunizations urged people under 60 to wait for the Pfizer vaccine. Politicians bickered, the local media attacked the AstraZeneca vaccine relentlessly, and vaccine hesitancy spread. With its vaccination rate the lowest among high-income countries, Australia was a sitting duck for Delta’s arrival.

The variant’s increased virulence, combined with Australia’s winter weather, has led to multiple, rapid outbreaks across the country, including ones spread by an unvaccinated airport limousine driver and an unvaccinated Covid-19 hospital receptionist. In its desperation to acquire doses of the Pfizer mRNA vaccine, Australia embarrassingly sought 500,000 vaccines from the Covax stockpile, intended for low-income countries, and has received doses from Poland, Britain and Singapore.

Vaccinations are increasing, yet hopes of a meaningful easing of restrictions may still be months away. It’s unclear whether the draconian restrictions will continue to be effective against Delta.

Today, Australia’s border remains closed; citizens must request permission to leave or enter the country, and incoming travel quotas were recently slashed in an attempt to stem rising cases. Although the country was able to safely shepherd home more than 200,000 returning Australians through its 14-day hotel quarantine system, more cases are escaping now than before.

Governments are increasingly relying on police and military forces for enforcement, and lockdowns are costing the Australian economy billions. In spite of restrictions, case numbers continue to rise, and “Covid zero” is becoming increasingly out of reach. Australians are tired, frustrated and lonely, and recent protests are turning violent.

So what now?

Australia is at a stalemate: Unable to quash the Delta variant with previously effective tactics, the country needs a new approach.

A government-commissioned modeling report from Melbourne’s leading Doherty Institute charted some easing of restrictions after 70 to 80 percent of the adult population is fully vaccinated. By current forecasts, however, this level of vaccination may be possible only by November, depending on vaccine supply and community cooperation. Although experts have suggested that the number of daily cases should not hinder Australia’s desire to open up, it is disconcerting to consider easing restrictions with thousands of cases per day.

As doctors who have treated many Covid-19 patients in Melbourne and Sydney, we have seen the ravages of the virus firsthand, and many fear for the health system’s ability to cope when restrictions are inevitably loosened. There’s a backlog of nonurgent procedures to catch up on, and many people have avoided medical attention out of fear of Covid exposure. We are concerned for Australia’s Indigenous population, given Covid’s disproportionate impact on disenfranchised minorities in other countries.

At some point, Australia’s political and health leaders must acknowledge that the country cannot escape Covid forever and must prepare the community to live with Covid.

To do so, Australia must add fuel to its vaccination rollout through incentives; immunization stations in accessible locations such as shopping centers; requiring vaccine passports at venues, for events and for travel; and a targeted marketing campaign to get more people vaccinated.

Australia will also need to keep reasonable public health restrictions for the short to medium term, including indoor masking, avoiding large events and using its test, trace, isolate and quarantine system. As leaders encourage people to adhere to restrictions in the coming weeks, they must simultaneously begin to prepare Australians for the likelihood that there will be high case numbers when restrictions ease. This will be a sizable shift in expectations, given Covid’s relatively low local prevalence so far.

Less than a year ago, people watched Australians enjoy their blissful summer largely free from Covid and from restrictions. Now we watch vaccinated friends in other countries return to a near-normal life amid the harsh reality that Australia may still have months of lockdown ahead. Once the envy of the world, Australia has come to a complete standstill — unable to return to the panacea of Covid zero it once enjoyed, yet far from ready to embrace the Covid normal of tomorrow.

Edward Cliff is a hematology doctor in Melbourne and a Fulbright scholar. Brian Fernandes is a palliative care doctor in Sydney, with a master’s degree in health policy from the University of Sydney. Both worked extensively in Covid-19 wards.

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