Politics – Page 3 – Gordon Gregory's blog

Covid 19 has revealed the weaknesses but also the importance of globalisation

19 July 2021

If enough of us ever get vaccinated to get over the immediate emergency, it will be useful to take time to reflect on the medium-term implications of the global pandemic for the governance of Australia and the world. There is much to be done and much we can learn.

The pandemic has thrown new light on the benefits and costs of globalisation.

The economic status of Australia and the well-being of its citizens are closely tied to aspects of globalisation. Australia is a relatively small economy with limited domestic demand. The nation has prospered through having natural resources in abundance which, given a worldwide free trade regime, can be sold to countries less well endowed.

However, the pandemic has woken Australia to the risks of too great a dependence on globalisation. It is now clear that the single most serious issue for the nation was supply of vaccine. In preparing for vaccination, the Federal Government made errors in commissioning and negotiating supply from other nations. This was compounded by decisions made by some of those other nations which were in their own interests and over which Australia had no control.

The problems posed by the absence of sovereign capacity to manufacture goods and services that become essential when the world faces a widespread emergency were apparent even before vaccination started. There were shortages of items of personal protective equipment and hand washing gel (in the days before we understood that soap and water was best). These were mitigated to some extent by the flexibility of some manufacturers who re-tooled rapidly; and by home-grown household activity, such as mask-making.

Incidentally, perhaps it would be wise to include toilet paper as a bottom-line commodity in forthcoming trade agreements that Australia signs.

On the other side of the globalism ledger, the pandemic led very rapidly to the effective closure of two of Australia’s major export sectors and employers: international tourism and international education. This was caused by interruption of another key element of globalism: the free and untrammelled movement of people around the world.

Fortunately, the export of natural resources, particularly iron ore and coal, as well as agricultural produce, seems to have proceeded unabated. The astonishing increase in the international price for iron ore, not related to the pandemic, has done much to shelter Australia from the worst economic effects of Covid-19.

Building manufacturing capacity and finding ways to make existing industries more resilient will have beneficial economic effects. Just as the shift to renewable energy sources is making new industries economic, so will national re-tooling for greater emergency self-sufficiency help to build Australia’s economy and provide employment opportunities.

In the 1960s manufacturing provided one quarter of GDP. By 2010 this had fallen to 6%, providing 8.6% of employment. In 2020 it was 4.2% of GDP and 7% of employment – or 853,000 people.

The Federal Government has indicated that it has plans for what it calls A Sovereign Manufacturing Capability Plan. It will apparently cover business opportunities both small and large, from manufacturing for niche markets right through to the production of guided weapons.

International agencies

As a middle-sized nation which benefits from both international trade and the rule of law, Australia has traditionally been a strong supporter of the bastions of globalism: multilateralism and international agencies. Once the health emergency is over it will be useful to scrutinise the performance of these agencies and to act on lessons learned about their structure, operation and value.

The agency most closely involved in the pandemic has obviously been the World Health Organisation (WHO). The majority view seems to be that the WHO had a poor start due to being slow in declaring the novel coronavirus outbreak ‘A public health emergency of international concern’, its highest level of alarm. Some commentators have attributed this to sensitivity about China’s potential reaction to such a declaration.

Since then, the WHO has been a critical and positive contributor to management of the pandemic. The challenge for the WHO was all the greater given that it was confronted by active opposition from the United States under Donald Trump. He cut funding for the WHO in May 2020.

Some of the WHO’s most important work is concerned with global vaccine equity and the gap between richer and poorer nations – the so-called ‘two-track pandemic’. The scale of this challenge is illustrated by the fact that several affluent countries are already discussing the rollout of booster shots to their populations, while the majority of people in developing countries—even front-line health workers— have still not received their first shot.

This is a matter that needs urgent international agreement and action, in which Australia, as an affluent country, should take an active part. There is much to be done in the medium term to make the world a fairer place before the next pandemic or similar crisis emerges.

The most critical immediate task in world health is to ensure that developing nations are given all necessary support for obtaining and using vaccines. Supply in sufficient quantities is the core challenge and spreading it fairly between richer and poorer nations. One way to achieve this would be to assist medium-sized countries to establish the capacity for producing vaccines. Cost is a key factor and it is to be hoped that ways can be found for the sort of generosity shown by governments and the private sector over the last 18 months to continue to be demonstrated.

Given the massive impact on world trade and damage to the budgets of all countries, including those that are affluent that have been donors of international aid, the impact of the Covid-19 emergency on the people and governments of poorer countries may yet become unmanageable. Much will depend on the role played by international aid and trade in the new order.

One particular example of successful collaborative international action is COVAX. Its aim is to accelerate the development and manufacture of Covid-19 vaccines, and to guarantee fair and equitable access for every country in the world. Among other things it is working to ensure that donations of vaccine to developing countries are synchronized with national vaccine deployment plans.

Apart from the WHO, international agencies concerned with the pandemic include the International Monetary Fund (IMF), the World Trade Organisation (WTO), the World Bank and the OECD.

The IMF is preparing a Special Drawing Rights (SDR) allocation to boost the financial reserves and liquidity of its members.

The WTO is involved because cooperation on trade is needed to ensure free cross-border flows and increasing supplies of raw materials and finished vaccines. It is working on negotiations towards a solution around intellectual property, which remains the main sticking point in relation to making medications available at low prices. The WTO is also working on freeing up supply chains for vaccines and other medicines.

The World Bank has provided a $12 million financing facility for vaccination and has vaccine projects in some 50 countries.

In anticipation of an end to the immediate Covid crisis, preparations can begin for evaluation of the way international agencies have performed since the beginning of 2020.

Note: a modified version of this piece was published as Part 1 of Preparing for an evaluation of Australia’s response to the Covid-19, 13 July 2021.

Making good use of the AstraZeneca in which we are ‘awash’

Jul 28, 2021

Thanks to the Delta variant, the Covid-19 pandemic is now a national crisis. If the vaccine roll-out can find both the urgency and the administrative efficiency required, the immediate challenge stemming from an excess supply of AstraZeneca and an acute shortage of Pfizer can be met. While steps are being taken to divert Pfizer from second doses to first, the large numbers who are waiting for the second AstraZeneca can be invited to have their second after less than 12 weeks have elapsed.

With just one critical piece of scientific evidence plus considerably more administrative dexterity than has been shown to date, much of the AstraZeneca already available can be used effectively in the next 4 to 6 weeks. This would utilise a valuable resource, boost the national vaccination rate, and provide time for an information, incentive and campaigning blitz to encourage greater confidence in AstraZeneca in the future.

The evidence available online is that the first AstraZeneca jab results in something between “barely any” efficacy against infection (as reported in a recent article in Nature) and 30% (as reported in an interview last week on RN with Assoc. Prof. Margie Danchin). For immunity given by the first AstraZeneca jab against hospitalisation due to Covid, the range is from “barely any” to 71%.

Those same two sources report the efficacy of the second AstraZeneca vaccination, given 12 weeks after the first, results in 67% against infection, and 92% against hospitalisation.

If the relationship between time and the effect of bringing forward the second jab is a straight line pro rata, the efficacy vis-à-vis infection after 4 weeks would be 42%, and against hospitalisation, 78%.

The significant discrepancy between various reported studies of the efficacy after the first jab (‘barely any’ to 30%; and barely any to 71%) are a problem – but not in the context of the proposal described in this piece. That is because the people involved in it are those who have already had the first. The decision they would be asked to make is determined by the evidence about the effect of the second.

Belief in the case that reducing the gap to less than 12 weeks has little impact on efficacy is strengthened by a heroic use of anecdotal evidence – as distinct from good science. On 11 July Norman Swan reported on Twitter that he had just had his second AstraZeneca vaccination:

“A bit less than nine weeks since the first. Willing to accept a little lower immune response to get protection against severe disease.” (Norman Swan, 11 July 2021)

If one needs to make a heroic assumption based on a single case, in my view there could hardly be anyone in a better position of trust than Dr Norman Swan.

There have been 6.1 million doses of AstraZeneca given, the majority of them to people over 60, but a significant number (c. 900,000) to 50-60 year olds and a smaller number of people younger still. These younger people are those who responded positively to the (controversial) encouragement by the Prime Minister on 28 June to make ‘a risk-based decision’ following consultation with the a GP – who would be indemnified against any risks resulting from an AstraZeneca vaccination to persons under 60 who requested it.

There is about a 4-8 week window of opportunity for a rapid surge in uptake of AstraZeneca. The 6.1 million are people who have already demonstrated their readiness to take AstraZeneca – although some may now be more AstraZeneca shy than they were initially. Given the 12-week delay normally required, and the fact that AstraZeneca jabs only started in early March, there must be 3 to 4 million who have got some further time to wait before their regular second, all of whom could be encouraged to bring forward that second. (Some have been turned off AstraZeneca so much that they have postponed their second.)

The threshold fact is what the science tells us about the loss of efficacy per week of advancement.

If the evidence is that there is just a modest loss, then we could be sure that a significant proportion of the 3 to 4 million would volunteer to sacrifice some immunity for temporal (and national community) gain. Some would go out of their way and take on board some level of risk to contribute to a demonstration of Australia’s community spirit. And it would give our governments another string to their bow – although to date they have shown themselves to be pretty hapless archers.

To be successful the roll-out would need effective national leadership to:

put the initiative firmly and clearly on the public agenda;
back the announcement with a clear statement from a reputable body or bodies about how much efficacy is lost per week from bringing the second dose forward;
get it done – through the hubs specially established, through GPs and maybe through pharmacists, who are now joining the campaign in number.

The initiative could be one of the special reserves of pharmacy in the rollout, giving them a greater sense of ownership and investment in the national operation.

Whether pharmacists and a special role or not, the administrative dexterity required would include the capacity to contact all of those who have had a first AstraZeneca vaccination inviting them to have their second before 12 weeks have elapsed.

To date, very little dexterity and absolutely no urgency have been in evidence in the vaccine program. But it is not too late to discover and demonstrate such characteristics.

So while the crisis management is diverting scarce Pfizer resources from second vaccinations to first, a portion of the 3 to 4 million people who have already demonstrated their willingness to have AstraZeneca can be used to mop up the domestically-produced vaccine in which the nation, paradoxically and tragically, is awash.

Even if the news about the immunity lost per week is not so benign, it is likely that a significant proportion of this cohort would provide an immediate and significant boost to the overall coverage of vaccination and confidence in AstraZeneca. Many would be glad to do their bit to attest to the fact that Australia is a strong community and would be happy to receive a call to bring forward their second AstraZeneca jab.

Others in that cohort would make the quite rational decision to trade a little lower immunity for more immediate coverage.

There is limited time to invest in this fix for a part of the crisis we face.

Note: this piece was first published in Pearls and Irritations on 28 July 2021. https://johnmenadue.com/making-good-use-of-the-astrazeneca-in-which-we-are-awash/

Preparing for an evaluation of Australia’s response to the Covid-19 pandemic – Part 3

_{Note: these three pieces were written over a week ago and things move very fast with the Covid-19 pandemic! The pieces are ‘published’¹ here as a record of my views at a particular moment in time, notwithstanding the crowded space which is commentary on the pandemic and the updating that might be necessary. Among the revisions that could be noted is a reappraisal of the politics of National Cabinet, which have festered somewhat. [¹ The word implies a move to expose the piece to global gaze. In fact the blogg doesn’t even have global immediate family readership. The world is too congested.]}

If enough of us get vaccinated to move beyond the immediate emergency, it will be useful to reflect on the medium-term implications of the global pandemic for the governance of Australia and the world. As well as the gloom and uncertainty, there have already been just a few welcome developments and there will be more to unearth.

PART 3: Some better news

National Cabinet

One of the most positive developments in governance to have emerged during the pandemic was a National Cabinet. This worked well for some time and showed the value of close collaboration between all governments on issues of urgency and national significance. It was so successful that, for a while, it no doubt increased the public’s respect for government and politics – albeit from a very low base.

Questions have already been asked about whether the partial success of this National Cabinet suggests ways in which inter-governmental work (including meetings about Federal fiscal relations) can be undertaken in a manner that improves on the Council of Australian Governments (COAG) model.

That is not to say that the National Cabinet for Covid was devoid of politics. During the period when it was cohesive and decisive, the Federal Government was not averse to taking advantage of the (politically desirable) position of backing the options that were most popular, knowing that, in fact, decisions on these matters were not within their compass. This was the case with lockdowns in general, and with parts of lockdowns such as school closure, masks and inter-State travel.

With schools, for example, for some time the Prime Minister was able to argue the critical value of schooling, the difficulties with home schooling, and to express the general belief that, for these reasons, schools should remain open. All the while, decisions on the matter lay with the States and Territories.

The National Cabinet was faced with the challenge of balancing health (as measured by cases, hospitalisations and deaths) against the economic and social effects of lockdowns. To date it has been unwise or unpopular to be too explicit about this balance. All governments, at least as far as public commitments have been concerned, have leaned towards suppressing the virus as a prerequisite for economic recovery.

Of the decisions made by the National Cabinet, none was more important than the one relating to quarantine. International quarantine is a Federal responsibility but decisions on internal borders lie with the States and Territories. Tasmania locked its borders on 19 March 2020. Australia’s national borders were closed the following day and on 24 March Australians were prohibited from leaving the country.

Thus it was that a complex, layered Commonwealth-State system emerged in relation to quarantine. The Federal Government took the decision to require all overseas arrivals to quarantine for 14 days. And through National Cabinet the States and Territories agreed to run hotel quarantine as part of their responsibility for public health. They also agreed to fund most of it.

This turned out to be a massive false economy for the Commonwealth. The fact that there has been no national system or standardised procedures for hotel quarantine has been one of the causes of the leakages from the hotels involved. These have resulted in huge financial commitments from the Commonwealth to support the economies affected by lockdowns determined and managed by the States and Territories.

For any kind of National Cabinet arrangement to persist will require leadership from the Commonwealth. And the situation in which one level of government makes lockdown decisions with another picking up the bulk of the economic costs that result looks like an unlikely bargain.

Decisions are ‘evidence based’

One of the phrases we have heard most often during the pandemic is when governments, federal and state, have attributed a decision to “the best possible advice from the health experts”.

It is surely a positive development for policy decisions to be made on the basis of scientific and other real evidence. Some parts of the world have had their fill of ‘alternative facts’.

The thought that occurs is what other issues have the same characteristics as a viral pandemic and, also, are accompanied by the same volume of applicable science. Climate change is one obvious case. And perhaps the challenge of improving the health and well-being of Australia’s Aboriginal and Torres Strait Islander people is another.

The considerations of the Chief Medical Officers have enabled governments to say, in effect, “Don’t blame or credit us governments; we are simply following independent, world’s best scientific advice.” In turn, the Chief Medical Officers have been guided by modelling of COVID-19 transmission and infection dynamics. It is perhaps surprising to note that the only three pieces I posted in the early days of the pandemic (April 2020) focused on modelling and a re-reading of them shows very little that needs to be revised or regretted. An extract from the post of 10 April 2020 is at the end of this piece.

It could be argued that governments’ constant deferral to scientific advice is a kind of delegation of responsibility and avoidance of accountability. It is politically attractive to have someone to blame for difficult decisions or to blame if decisions taken were the wrong ones. But one cannot argue against the idea that all policy decisions should be determined on the basis of evidence from science.

The fact that the distribution of money for sports grants and suburban car parks has not been based on evidence is one of the reasons why there is such a lack of respect for and trust in governments and politics.

Institutional flexibility

The good things to have come out of the pandemic include an extra measure of flexibility in certain policy and regulatory matters.

Consider, for example, the supply of oxygen. The Australian New Zealand Industrial Gas Association is the peak body for suppliers of medical oxygen to hospitals and similar facilities. Because of the public benefits that would result, the Australian Competition and Consumer Commission (ACCC) has granted ANZIGA temporary authorisation to exchange information and work through arrangements which in other circumstances might be deemed to reduce competition in the sector.

Another positive spin-off from the pandemic has been the extension of publicly-funded telehealth services. When I was at the National Rural Health Alliance we battled persistently to achieve small steps forward on telehealth, one at a time, painfully and slowly! Over time there were extensions to the geographic areas in which funded telehealth was available; eligibility for additional health care settings, for additional professionals (eg specialist to GP link-ups), and for additional interventions (eg for mental health).

Rural people and their advocates were no doubt delighted when, for the pandemic, there were major extensions made in one fell swoop to telehealth services under Medicare. Some 300 additional items became eligible. Over 30 million services were claimed in the first six months at a cost of over $1.5 billion.

There will need to be evaluations. When they are done, telehealth and other things such as e-prescriptions and home delivery of medications should be evaluated as initiatives that make access to service more equitable, not only for what they do to facilitate social distancing or contactless care.

In the face of the pandemic, governments in other countries have granted pharmacists greater authority. In Canada, for example, pharmacists have been given opportunities to join actively in the fight against the virus. Aimed at assisting an overloaded health system, the extensions for pharmacy practice in that country have included performing COVID-19, influenza, and Group A Streptococcus screening tests, and vaccine administration.

In Australia, due almost certainly to the vexed political situation relating to medicine v. pharmacy, it is still unclear as to where and when pharmacists are involved in Covid vaccinations. In any case the vaccination ‘system’ is already mixed-mode and unclear enough.

It is to be hoped that the passing of the health emergency will not see the end of such sensible increased flexibility of these sorts.

Evaluations can start now

A main course of co-ordinated decision making on national emergencies, with better use of scientific evidence (when available) in making policy decisions, plus a larger serve of sensible flexibility may not seem to be much of a feast. But any trauma and disruption as great as the world is currently facing must yield some opportunities for positive change management as well as misery and uncertainty.

There is a huge range of matters that will need to be evaluated, at global and domestic levels and at every level in between. And it will include positive changes which may not yet be even contemplated.

Evaluation will be useful. And some of those qualified in the field should start soon.

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From the post to this blogg of 10 April 2020:

Modelling the transmission of infectious disease

Mathematical models of disease transmission can be used to estimate the potential impact of public health responses to infectious diseases. Recently (7 April) some details of the particular model that is being used as the basis for the decisions of Australian governments on the COVID-19 crisis have been published.

How do such models work? How can we be sure they are accurate? What do they tell us?

The headline findings from the modelling are the ones that have been delivered to us consistently in governments’ media conferences and other information activities:

“An uncontrolled COVID-19 epidemic would result in a situation dramatically exceeding the capacity of the Australian health system over a prolonged period, notwithstanding the increases in that capacity that are possible.”

“A combination of case-targeted isolation measures with general social measures will substantially reduce transmission and result in a more prolonged epidemic with lower peak incidence, fewer overall infections and fewer deaths.”

As we all know, we have to stay home.

How it works

These general prescriptions from the modelling are clear and largely unchallenged. But as time passes it will be good if there is closer scrutiny of this and other modelling. This will result in better understanding of both the general applicability of such modelling and the specific work being done on the Australian government’s preferred model.

The key variables on which mathematical models of infection are based are the latent period (i.e. the interval following exposure before an individual becomes infectious and transmits the disease), the infectious period (i.e. the period during which an infected person can transmit a pathogen to a susceptible host), and transmissibility. Transmissibility is described by the reproduction number – the number of secondary cases generated by a single infected case introduced into a susceptible population.

If the transmissibility number is less than 1, infection is receding. If it’s greater than 1, infection is spreading.

For models of this kind it is useful to know the extent to which outputs (in effect, the model’s predictions) change in response to a given amount of variation in its inputs, and the particular input to which altered outputs can be attributed. The inputs include both the assumptions made about the structure of the entity being modelled and the data fed in.

This is the business of uncertainty and sensitivity analysis. In effect they provide information about the robustness of the model – the probability of the model and its predictions being accurate reflections of reality. The greater the model’s uncertainty or sensitivity, the more its outputs change with a given amount of variation of its inputs – and the less useful it will be.

Such analyses can help check the accuracy of a model’s structure or specification by assessing the individual contribution of a variable and the need to include it or not.

They can also help interpret the results of a model by identifying thresholds for certain variables that trigger outcomes of interest.

The value of any such modelling is limited if the model’s structure is imperfect (that is, if it makes false assumptions about the relationships between elements of the model) or if incomplete or inaccurate data are fed into it. The modelling can be run again and again with greater confidence about its accuracy as, each time, more is known about the characteristics of the pathogen and more local (Australian) data are added in.

Critically, accurate estimation of the transmissibility of a disease requires reliable data on its incidence in the total population. As we have been told time and time again, this requires “testing, testing and testing”.

Preparing for an evaluation of Australia’s response to the Covid-19 pandemic – Part 2

This is the second of three posts on aspects of Australia’s Covid-19 response that it will be useful to analyse. The pandemic has exposed some hitherto under-emphasised realities of Australia’s federal system. Some of them are positive but a greater number can be described as challenges of the Federation.

PART 2: The Australian Federation

The pandemic has thrown new light on both the benefits and the challenges of Australia’s federal system. The positive elements include a new understanding of the need for inter-governmental cooperation within the nation and ways in which it can be effected, and some major (and rapid) changes in the way services are provided to the public. One example of the latter is how the pandemic led to a major extension of the provision of subsidised health services through telehealth.

However there is a longer list of issues relating to Australia’s governance that have emerged – in particular as it relates to service delivery – that are negative or even dysfunctional. Given their importance and general acceptability, some of the required changes to Australia’s system of governance that have come to light can and should be implemented as soon as possible.

Probably none is more serious (or more familiar) than the need to rationalise, re-order and clarify governmental responsibilities for health-, aged- and disability-care.

Australia’s care systems

Major reforms to the health, aged care and disability care systems have been called for by many people for very many years. But never before has there been such a naked, loud and transparent series of events that attest to the need for Big Reform to these care systems as have occurred during the Covid-19 pandemic.

Coupled with the Report of the Royal Commission into Aged Care Quality and Safety – an important piece of work, but just the latest in a long series of inquiries into aged care – the pandemic has surely demonstrated to everyone’s satisfaction that Australia’s aged care system needs massive, urgent change. It is under-funded, under-staffed and inadequately regulated.

To date the residential aged care sector in Victoria has been the location of the largest group of Covid deaths in Australia. Down the track it will be useful and important to unpick the evidence about rates of mortality, management and ownership structures, staffing, and emergency procedures in that sector.

The results of such analyses will be valuable in the consideration of changes that, at last, seem inevitable.

There are fundamental questions about whether the Commonwealth has the capacity and skills to manage aged care, including the regulation of staffing. The pandemic has also laid bare basic questions about the legal rights and responsibilities of residential aged care facilities, for instance in relation to the mandating of staff vaccination.

There will be studies and comparisons made of the performance of various Health Departments – Federal, State and Territory. In particular, their public health operations and staff will come under close scrutiny. Also under the microscope will be Australia’s body of public health and related health professionals, and the research, teaching and practice settings in which they work.

The universities will be able to claim the Australian response to the pandemic as evidence of the need for extra investment in public health and other health-related research and teaching, as well as in clinical practice.

It is certain that the capacity of our health system and the agencies within it to do effective public relations and communications (‘messaging’), and for the management of data, will come under particular scrutiny. Eighteen months ago we were promised an open approach to the decisions made in the pandemic and the modelling behind them, and the numbers of patients involved. In fact the data systems relating to the pandemic, and relating to vaccination in particular, have been appalling.

Efficiency of the public service

The pandemic has drawn attention to a number of matters related to the confidence and flexibility of institutions in the health sector. Given the daily widespread publicity associated with the pandemic, the public has had the opportunity to peek inside Health Departments and health research agencies. We have become familiar with some of the country’s epidemiologists and we now have some idea of what they do.

Overall Australia seems to be well-placed where public health management and research are concerned. As someone who has been glued to current affairs television, I can attest to the fact that the nation’s public health professionals have proved themselves to be a hard-working and charming lot, whether from research institutes, universities or state health agencies.

When it is time, there will inevitably be comparisons drawn between the various agencies that have been ‘out front’ during the pandemic. Underlying the criticism of the Federal response on vaccination is the question of the efficiency or competence of the Federal Department of Health. There will be comparisons of the efficiency with which various jurisdictions have undertaken the tracking and tracing work which have been so central to suppression of the virus.

At one stage in 2020 the differences in the apparent success of suppression activities as between the two largest States were attributed to the different structure of public health activity in the respective jurisdictions. This is the kind of assertion it will be useful to analyse.

One of the most surprising things has been a general inability of governments and the public service to inject a real sense of urgency into responses to the pandemic. This is particularly the case for the vaccination regime. The Commonwealth knowingly grabbed responsibility for vaccination at the beginning, presumably because it seemed to be an obvious way in which to win political points and public support. However it turns out that, on vaccines and vaccination, the Commonwealth is now being slowly hoist by its own petard.

The lack of urgency related to vaccination has been compounded by mixed messaging and uncertainty as to what arrangements relate to which parts of the population and to which vaccine at any given time. There has been no decent information campaign, no use of appropriate celebrities.

Clear messaging is important but is a second order issue if the target for the messaging is uncertain. A good campaign will be one that achieves some specific action or attitude. But it has not been clear whether ‘a good campaign’ would be one that moves people to be supportive of vaccination, or inspires them to get an appointment with ‘their GP’ (if they have one), or drive to a pop-up clinic, or attend a health clinic, ask at the local pharmacy, run the gauntlet of an on-line system or phone the dreaded telephone number to learn what number they are in the queue.

At the risk of seeming parochial, it may be that the ACT has been an exception to the charge of failing to take urgent action. Just down the road from my home, a cricket ground was transformed eighteen months ago into a temporary field hospital for Covid-19. It cost $23 million and was built in just 37 days. In May 2020 it was thought that it would never be used. It is now a vaccination hub for the administration of the Pfizer vaccine.

Care of vulnerable groups

One of the worst characteristics of the vaccination regime has been its failure to identify and treat population groups in order of their vulnerability to illness and hospitalisation as a result of Covid-19.

When comes the time for evaluation of what went wrong there will be important lessons to learn about who is vulnerable, in what settings, and how their needs can be swiftly met. It will be clear that there then needs to be clear communication of these priorities, built in to the schedule or road map made public.

So far, when it comes to protection from risks, elderly people in residential care and at home, and people with a disability, have been badly let down.

It was during the 2020 lockdown in Victoria that the majority of Australia’s pandemic deaths occurred. The greatest number of those deaths was among elderly patients in aged care accommodation. And in this group a disproportionate number were in private aged care institutions rather than the State’s public facilities. This raises the question as to whether there are some structural, attitudinal or operational characteristics of facilities in the various sectors which may help to explain the different rates of illness and mortality.

In contrast to care of the elderly and those with a disability, one of the standout successes of Australia’s suppression of the Covid-19 virus to date has been with Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander communities have barely been affected. It will be important and useful to understand how and why this has been the case – and critical to prioritise Aboriginal and Torres Strait Islander people in the vaccination queue, especially communities in more remote areas where there are limited numbers of health clinicians.

[See Part 3 of this post: Some better news]

Preparing for an evaluation of Australia’s response to the Covid-19 pandemic

If enough of us ever get vaccinated to overcome the immediate emergency, it will be useful to take time to reflect on the medium-term implications of the global pandemic for the governance of Australia and the world. There is much to be done and much we can learn. The first of three parts, this piece reflects on some of the global issues it will be useful to evaluate.

PART 1: Globalisation

The pandemic has thrown new light on the benefits and costs of globalisation.

However the pandemic has woken Australia to the risks of too great a dependence on globalisation. It is now clear that the single most serious issue for the nation is supply of vaccine. In preparing for vaccination, the Federal Government made errors in commissioning and negotiating supply from other nations. This was compounded by decisions made by some of those other nations which were in their own interests and over which Australia had no control.

Incidentally, perhaps it would be wise to include toilet paper as a bottom-line commodity in forthcoming trade agreements that Australia signs.

Fortunately the export of natural resources, particularly iron ore and coal, as well as agricultural produce, seems to have proceeded unabated. The astonishing increase in the international price for iron ore, not related to the pandemic, has done much to shelter Australia from the worst economic effects of Covid-19.

Moves to mitigate against inadequate supply of goods and services needed in an emergency, and in response to the decline of major industries, provide incentives for Australia to rebuild its manufacturing sector. In the 1960s manufacturing provided one quarter of GDP. By 2010 this had fallen to 6%, providing 8.6% of employment. In 2020 it was 4.2% of GDP and 7% of employment – or 853,000 people.

International agencies

Some of the WHO’s most important work is concerned with global vaccine equity and thegap between richer and poorer nations – the so-called ‘two-track pandemic’. The scale of this challenge is illustrated by the fact that several affluent countries are already discussing the rollout of booster shots to their populations, while the majority of people in developing countries—even front-line health workers— have still not received their first shot.

Much will depend on the role played by international aid and trade in the new order.

Apart from the WHO, international agencies concerned with the pandemic include the International Monetary Fund (IMF), the World Trade Organisation (WTO), the World Bank and the OECD.

The IMF is preparing a Special Drawing Rights (SDR) allocation to boost the financial reserves and liquidity of its members.

The World Bank has provided a $12 million financial facility for vaccination and has vaccine projects in some 50 countries.

In anticipation of an end to the immediate Covid crisis, preparations can begin for evaluation of the way international agencies have performed since the beginning of 2020.

Note: a version of this piece was published in Pearls and Irritations, 19 July 2021 as ‘Covid 19 has revealed the weaknesses but also the importance of globalisation.’

[See Part 2 in Aggravations.org: The Covid pandemic and the Australian Federation]

A punter’s guide to the review of Medicare items and the impact on patients’ out-of-pocket costs

How good is a race!

In the Current Health Policy Stakes, Covid-19 is still distancing all other runners. Back in the pack Men’s Health Week has been promoted to a spot on the rails, but it is the stayer Out-of-pocket Costs that takes the eye. His half-brother, Costs Paid by Patients for Surgery, is well placed, while Mental Illness seems to be finding the going tough. Remote General Practice (by Wayside Chapel out of ABC News Breakfast) is surprising her critics. However all of these, which are in effect racing for second place behind the pandemic, have an eye on Changes to Medicare. This experienced old galloper is threatening with a run down the middle of the course.

——–

A complex system

The system of payment for medical treatment in Australia is fiendishly complex. Before we set out on a brief explication, it will be useful to remember that doctors are Business People, specialists are Big End of Town Business People, and insurance companies have commercial interests that span the divide between patient and specialist.

Another significant divide is between those who have private health insurance and those who do not. Only families who might be described as ‘middle-income and above’ can afford private health insurance, which reflects some of the growing inequality among Australian families. Families with low incomes have free access to the services of a public hospital, including for surgery, but are merely bystanders to the private health system.

The proposed changes currently being implemented do not pose a threat to the general principles of Medicare, which are to give all eligible persons the choice to receive, free of charge: the services provided by public hospitals; no-cost or low-cost services from general practitioners and certain medical specialists; and no-cost or low-cost access to medicines listed on the Schedule of Pharmaceutical Benefits. So, experienced though she is, Changes to Medicare should not end up in the winner’s circle.

Medicine means business

Medicare pays a significant amount towards the costs of surgery, regardless of whether the patient has private health insurance or not.

Every particular surgical procedure has a ‘descriptor’ and a standard cost (or fee) struck by the government. Each descriptor defines precisely what the item entails.

The list of descriptors and standard costs is the Medicare Benefits Schedule (MBS). If the procedure is undertaken on a public patient in a public hospital they will have no out-of-pocket costs. The provider (the hospital and surgical team) will in effect earn just the schedule fee.

There are two critical factors in determining how much a patient will pay for surgery. First, each surgeon has the right to charge whatever fee they wish. They are not bound by the standard fee set for the MBS. Second is the patient’s choice of insurer and that insurer’s arrangements with the surgeon who does the job.

So, for example, if the surgeon sets their fee for a particular procedure at 120% of the schedule fee, the MBS will pay 75%, the insurance company 25%, and the patient 20% from their own pocket.

Families with private health insurance are the lucky ones. They would probably be surprised to know that, ironic though it may seem, they are in the hands of insurance companies when it comes to the costs they will pay for surgery. The health insurance companies negotiate commercial agreements with specialists on behalf of patients.

A ‘known gap’ agreement has the insurer entering into a contract with the surgeon so that the patient’s out-of-pocket payment is fixed and known in advance. With a ‘no gap’ agreement the insurer pays the full amount of the difference between the schedule fee and the surgeon’s fee. All of these agreements will need to be reviewed as a result of the MBS review’s recently released recommendations.

Even where there is a no gap arrangement, to avoid what is called ‘bill shock’, the patient needs to find out beforehand what costs associated with the surgery are not subject to the arrangement between the insurer and the surgeon. These unavoidable other costs may include the anaesthetist’s fee, the cost of pathology undertaken as part of the procedure and perhaps medications.

The waiting lists for surgery in public hospitals are much longer than for private patients – those who have health insurance. As well as having less time to wait, private patients can choose the surgeon who will undertake the procedure. (And their hospital room will be nicer.)

For a private patient the MBS pays 75% of the schedule fee. And if that patient’s health insurance company has an arrangement with the surgeon, that company will pay the remaining 25% of the schedule fee (if they have a ‘no gap’ agreement with the surgeon) or a specified amount up to 25% (under a ‘known gap’ agreement).

What has been reviewed?

In 2015 a review of all 5,700 Medicare item numbers began. It was to check on which health service items should continue to be included in the Medicare payment system; how each one is described (the descriptor); and the schedule fee that was to apply for each.

Such a review is sensible and there has been general support for the updating of the standard prices for particular items and of the descriptors. The review involved separate committees for each area of the MBS, and there were extensive consultations.

The government has already announced changes to the items relating to many areas of medicine, some of them in the May 2021 Budget. They have included intensive care, diagnostic imaging, chemotherapy, gynaecology, and pain management.

The final report was presented to the government in late 2020. It contains 156 changes to general surgery items, 594 to orthopaedic surgery, and 135 to heart surgery items.

It is not the substance of the proposed changes that have upset medical interests, but their timing. Even when it is managed effectively it is hard enough for the government of the day to meet the political challenge of making changes to Medicare, given how much it is relied upon and supported by the Australian public.

This time the government seems to have shot itself in the foot. It has announced that, from 1 July, the rebates payable for private orthopaedic, general and heart surgeries will change. This gives surgeons and health insurers very little time to agree new no-cost and low-cost contracts.

Insurers could use the opportunity provided by these negotiations to bring down the level of fees, which would enable them to reduce the cost of their insurance packages. But unfortunately there isn’t a flying pig in the Current Health Policy Stakes.

Why does Victoria top the score?

One of the aspects of the Covid-19 pandemic which will certainly be the subject of inquiry in Australia once things have settled down is why Victoria has had more lockdowns and cases than the other States. And it’s not the first time Victoria has been in this position. How McDougall Topped the Score, written by Thomas E. Spencer, has been re-made and is shown below. It will remind readers of the Swine Flu epidemic of 2009 in which Victoria also set some records.

(Note: I posted a version of the poem, but not the COVID comments, on 9 March but given what is happening in Victoria it deserves another go. I look forward to the time when it is no longer relevant.)

At the time of writing (29 May 2021) there have been 30,073 cases of COVID-19 in Australia, 20,580 of which have been in Victoria. Of the 910 deaths recorded, 820 have been Victorians.

This represents an extraordinary imbalance between States.

A number of possible explanations for the disparity have been canvassed.

One is that the different structure of public health services in Victoria as distinct from, say, New South Wales has resulted in greater effectiveness in the latter. It may be that the pre-existing New South Wales system was more compatible with what was needed for effective contact tracing. New South Wales has decentralised Local Area Health Districts with public health teams embedded in local communities. These teams work independently while being guided by New South Wales Health centrally.

Catherine Bennett, Chair in Epidemiology at Deakin University and a key contributor to public understanding and debate, wrote in The Conversation in October 2020:

“NSW’s system of devolved public health units and teams meant when local outbreaks occurred, locally embedded health workers were at an advantage. They’re already linked with local area health providers for testing, they already have relationships with community members and community leaders, and they know the physical layout of the area.”

“What’s crucial is a nuanced understanding of local, social, and cultural factors that may facilitate spread or affect how people understand self-isolation and what’s being asked of them. It can also make a critical difference in encouraging people to come forward for testing.”

“If local health workers and contact tracers are already part of a community, they can bring that expert knowledge into the mix; they can make sure public health messaging is meaningful for local communities.”

In contrast to the situation in NSW, Victoria has a public health system which is highly centralised, meaning there was a smaller base upon which to build a surge contact tracing capacity. The fact that some help was provided to Victoria from interstate staff and defence force personnel may be seen as evidence on the matter.

The different capacity of these two State systems may also be due to their recent history of funding relative to need. On the other side of the ledger is the fact that a centralised system may be better able to handle large quantities of data.

Another possible cause of the inter-State disparity is the difference in the structure of residential aged care. Of the 910 deaths recorded nationally, 685 have been in residential aged care facilities. And 655 of these have been in Victoria.

Compared with NSW, Victoria’s residential aged care system has a larger proportion of private for-profit businesses, which may have put profit before service. In Victoria 54% of residential aged care places are in the private, for-profit sector (including both family-owned and public companies) compared with 35% in NSW. In contrast, 37% of Victoria’s aged care places are in the not-for-profit sector (including religious, charitable and community-based organisations), compared with 63% in NSW. Much more evidence would be needed to conclude that the profit motive is at the heart of the difference between the two States.

One of the reasons why Australia has done so well in response to the pandemic is that we have been regularly and expertly provided with scientific evidence. This has contributed to the high level of compliance in Australia with the steps that have been necessary.

In my view, two expert commentators have stood out. Norman Swan has been tremendously busy including with the ABC’s daily Coronavirus podcast. Norman came to the business of COVID with an existing good reputation as a well-credentialed scientist and is a very experienced communicator. Another expert who has worked tirelessly and presented with great clarity, dignity and modesty is Mary-Louise McLaws, Professor of Epidemiology at the University of New South Wales.

On ABC’s weekend breakfast TV show today, when asked for her views on why Victoria has suffered more than the other jurisdictions, Mary-Louise said that Melbourne is a very close-knit community. It is a city that’s easy to get around, she said, so sadly it is easy for a virus to spread. Melbourne is the city of most concern in Australia for explosions of case numbers.

This means that enquiries into Australia’s COVID experience will need to include cultural, logistical, demographic, economic and sociological factors.

History repeating itself?

This is not the first time Victoria has stood out as the worst affected part of Australia in an epidemic. On 8 June 2009 The Australian newspaper informed its readers that, at that time, the State of Victoria had the highest recorded per capita rate of H1N1 Influenza 2 (Human Swine flu) in the world. It had the fourth highest number of infections worldwide after the US, Mexico and Canada, but the highest per capita load.

Victoria was being blamed for exporting the virus around Australia.

Eventually the official record showed 37,537 cases in Australia and 191 deaths associated with Swine Flu were reported by the Department of Health. The actual numbers were probably much larger as only serious cases warranted being tested and treated. Sources say that as many as 1600 Australians may actually have died.

How McDougall Topped the Score, written by Thomas E. Spencer, was first published in The Bulletin in March 1898. The cricketing cred. of the poem was enhanced when a piece entitled The Prerogative of Piper’s Flat was given as an encore to the McDougall poem at a public reception for the great, the elegant Victor Trumper in Sydney Town Hall on 19 December 1903.

In June 2009 I wrote a companion piece to Spencer’s, based on the facts as reported in the Australian. So much of the content of the piece seems relevant today that I am bold enough to hope you will get something out of it.

Reminders

Given the time that has elapsed since June 2009 some further background will be useful for those who read the piece. On 23 May the Federal Government classified the Swine Flu outbreak as being in the CONTAIN phase. Victoria was escalated to the SUSTAIN phase on 3 June. This gave government authorities permission to close schools to slow the spread of the disease. On 17 June 2009 the Department of Health and Ageing introduced a new phase called PROTECT. This modified the response to focus on people with high risk of complications from the disease.

At the time Australia had a stockpile of 8.7 million doses of Tamiflu and Relenza. A large scale immunization effort against swine flu started on Monday 28 September 2009. By then Victoria had 2,440 cases and 24 deaths. The Victorian health authorities closed Clifton Hill Primary School for two days (sic) on 21 May (shock, horror).

Tamiflu was a Roche product, Relenza a GSK product. (In 2014 researchers threw doubt on the effectiveness of Tamiflu and thus on the value of governments stockpiling it.) In June 2009 the Minister for Health was Nicola Roxon, Member for Gellibrand, an inner-Melbourne electorate. Coincidentally, in 2015 Tadryn bought a house in Footscray, within spitting distance of Whitten Oval. As well as describing folks from Mexico, the term ‘Mexicans’ is used by people from States to the north to refer to people from Victoria. Australia’s Chief Medical Officer in 2009 was Jim Bishop.

How Victoria Topped the Score

A peaceful spot is Gellibrand – and many local folk

Exist by work in railways, and paper, tyres and rope

The views to sea are legend and the people, quite untaught –

Lean naturally to leftwards, as portside people ought

Still the climate is erratic as the natives always knew

And the winters damp and gusty bring on frequent bouts of flu

But the locals now are Tami-rous as never were before

As H1N1 gets around – and Victoria tops the score.

It’s 90 square kilometres right to Port Philip Bay

Embracing Whitten Oval where the Bulldogs hone their play

Includes Altona Meadows where the views are simply grand

And other lovely places now warehousing used to stand

From Spotswood through to Tottenham employment, once serene,

Depends on heavy industry, petrochemical, marine

The local folks are very proud, be they so rich or poor

But they all might be affected as Victoria tops the score.

It’s Inner Metropolitan (GPs’ incentives: nil –

For the local branch of the AMA this is a bitter pill)

So when a virus came along – exclusion was in vain –

The local health care services got ready for the strain.

Local people everywhere did all that they were asked

And courses sprang up all around on kissing through a mask

A local hero came along: Gellibrander to the core

Who meant to keep the lid on it – tho’ Victoria topped the score.

This hero was a lawyer and a trusted one at that

And in the middle order for young Kevin she would bat

She trained her loyal staffers how to listen and to scout

For useful tips, intelligence, whatever was about

And each succeeding night they worked ’til the light it was a blur

Sometimes our hero struck a thought, sometimes a thought struck her

’Til one day news from Mexico of which she’d hear much more

That swine flu was now all the rage – not too long from our shore.

The national plans were then rolled out – even Bishops were involved

Good health care teams and scientists all helped to have it solved

No stone was left un-x-rayed and surveillance was maintained

And people’s sensitivity was measured when de-planed

A hotline was established but it very soon was broke

And crackling then was all it gave to its inquiring folk

The public mind was set at ease, there sure was nothing more

And New South Wales got uppity, as Victoria topped the score.

Victoria’s reached a thousand and some medics now complain

Even tho’ officially it’s-on ‘modified sustain’

If children want to miss exams and have a full week off

They simply visit Gellibrand and then begin to cough

We all will do whate’er we can to try to keep the peace

We’ll quit the smokes and exercise ’gin morbidly obese

This gentle flu, still not a swine, in countries seventy four

And here it’s still Victoria that easy tops the score

This illness from the Mexicans is causing a to-do

And now is a pandemic if you credit you-know-WHO

But guided safely as we are from right the very top

We’re confident that this will pass, it’s likely soon to stop

So raise a glass – or a long pipette – to our Gellibrander boss

‘Cos even tho it’s not too strong it makes us all la-cross

And there may well be an upside – tho’ it’s touchy this to broach

For you won’t catch a cold at all just now if your shares are still with Roche

So let’s consign to history, make part of national lore

The time when, quite unwillingly, Victoria topped the score

‘Picking winners’ for a new economy

The Treasurer says the JobKeeper program needs to end because it’s having the perverse effect of preventing workers “more efficiently moving to other roles across the economy” and because “it can prop up what are unsustainable long-term businesses” (ABC’s 7:30 Report, 11 March 2021).

It is at best ironic or at worst inconsistent that, on the same day, the Government announced a $1.2 billion support package for the airlines and tourism industries. Part of the package will provide 800,000 half-price airfares to (initially) 13 tourism-reliant regions, selected on the basis that they are among the worst-affected by the pandemic.

The new program will commit what market economists regard as one of the greatest sins open to a government: to provide differential support to different places, population groups or industries. The pejorative term is ‘picking winners’.

The sin is compounded when the criteria by which inclusion/exclusion decisions are made are not clear. Accountability is missing. People are already asking about the criteria that led to Darwin and Adelaide being included in the program within 24 hours of its announcement,

Although they are more modest in terms of scope and expenditure, suspicions about how grant programs such as for sports infrastructure and regional growth funds have been managed contribute to the situation in which government intervention is not trusted. One particular issue is the role played by ‘Ministerial discretion’ in the allocations made. The Morrison government is fortunate that the pandemic has given the media and the public bigger fish to fry than assertions about the misallocation of grant funds.

The inconsistency of decisions about JobKeeper and the new tourism package need to be seen in the context of both their immediate effects on employment and their medium-term impact on structural change in the economy. ‘Structural change’ is not a phrase to light up the synapses in many heads, but it is critical.

The economic challenges faced by Australia as a result of the COVID-19 pandemic are just the latest emanations of the need for a national economy to change itself in order to better meet the needs of labour and capital. Without warning or prudent preparation, Australia is experiencing the effects of the radical and sudden downsizing of two of its largest industries

With Australia’s international borders shut, the overseas student sector has virtually disappeared, at least for a year or two. Australian institutions are faced with the urgent need to provide new and different services.

Waiting for normal service to be resumed.

The same applies to the nation’s overseas tourist sector. Before the pandemic, tourism as a whole was a $152 billion industry for Australia, with a substantial part of it being through visitors from overseas.

Unlike most structural change, the loss of jobs in these two industries has been at a stroke, and caused by a single event beyond the control of any government. The precipitous nature of the change has made the job losses that have occurred even more difficult to manage.

A new economy has to be fashioned.

Although the speed at which the change has occurred is unusual, the key policy questions confronting the Government are the same as ever. They concern the ‘best’ speed at which structural change should occur; and the modes of intervention that should be employed.

The first of these policy questions is premised on an indisputable fact: through the degree and nature of its interventions, governments can, to a meaningful extent, manage the national speed of structural change in the economy.

The consequence of the speed of structural change occurring can be measured in terms of the number of people who lose work they used to have, and the number who cannot break into the job market at all. The speed of change determines the amount of stress (unemployment, underemployment, social cohesion, anguish and illness) caused. The more rapid the change, the greater the stress and disruption.

The options available for government intervention include an emphasis on education, training and retraining; payments of social support; incentives for the relocation of people or industries; countervailing government investment in the declining industries; and incentives for economic development or business subsidies – potentially per place or industry, as with the current tourism package.

The best option for Australian Government’s intervention in economic structural change is likely now to be different given the sudden limits to economic globalism that have emerged.

Structural change is necessary in any economy if it is to maximise the opportunities for work and returns to invested resources. The government of the day must strike a balance. That balance lies somewhere between intervening too much and so slowing down the rate at which desirable change occurs in the mix of industries in the economy; and intervening too little such that the aggregate cost to persons and communities in terms of the stresses experienced is deemed to be excessive.

There are always various judgements from different individuals and agencies about where this best balance lies. It demonstrates once again that policy-making for a national economy is extremely complex. This is particularly the case when there has been a failure to anticipate events that have very serious consequences for employment and income.

How Victoria Topped the Score

McDougall and Pincher prepare for the match

To people of a poetic and keen imagination, Victoria’s experience to date with COVID-19 was pretty much anticipated in The Bulletin of 1898.

That was when the report of the cricket match between Piper’s Flat and Molongo, curated by Thomas E. Spencer, was published.

The game looked lost for Piper’s Flat until McDougall (“canny Scotsman”) and Pincher combined to turn things around. Brett Sutton – like McDougall – has played the innings of his life and Premier Andrews, just like Pincher, has steadfastly refused to drop the ball.

Standing as a modest link between these two momentous events is a piece entitled How Victoria Topped the Score which detailed the situation with Swine Flu that confronted the State in 2009.

To remind, the background is this. In June 2009 the Australian newspaper reported that Victoria had the fourth highest number of H1N1 Influenza (Human Swine Flu) infections worldwide after the US, Mexico and Canada, but the highest per capita load. It was being blamed for exporting the virus around Australia. Sound familiar?

Working at the time in the health field and seeing the value of a positive outlook in stressful situations, I took the liberty of re-framing Spencer’s piece around Victoria’s plight with H1N1.

Recollection of certain facts will help appreciate the 2009 piece. The Federal Minister for Health was Nicola Roxon, the Member for Gellibrand, an inner-Melbourne electorate. The Commonwealth Chief Medical Officer was Professor Jim Bishop. Tamiflu is a Roche product, Relenza a GSK product. In 2014 researchers threw doubt on the effectiveness of Tamiflu and thus of the value of governments stockpiling it. The swine flu epidemic originated in Mexico; and in inter-State veterans’ hockey the Victorians are known as Mexicans, being from South of the border.

And Wikipedia reports as follows:

“On 23 May 2009 the federal government classified the outbreak as CONTAIN phase except in Victoria where it was escalated to the SUSTAIN phase on 3 June. This gives government authorities permission to close schools to slow the spread of the disease. On 17 June 2009 the Department of Health and Ageing introduced a new phase called PROTECT. This modified the response to focus on people with high risk of complications from the disease. Australia has a stockpile of 8.7 million doses of Tamiflu and Relenza. A large scale immunization effort against swine flu started on Monday 28 September 2009. In Victoria there have been 2,440 cases, including 24 deaths. Victorian health authorities closed Clifton Hill Primary School for two days on 21 May.”

Today we are likely to be less horrified than before at the closure of a school for two days on public health grounds.

How Victoria Topped the Score

Gordon Gregory

(after Thomas E. Spencer)

15 June 2009

A peaceful spot is Gellibrand – and many local folk

Exist by work in railways, and paper, tyres and rope.

The views to sea are legend and the people, quite untaught –

Lean naturally to leftwards, as portside people ought.

Still the climate is erratic as the natives always knew

And the winters damp and gusty bring on frequent bouts of flu.

But the locals now are Tami-rous as never were before

As H1N1 gets around – and Victoria tops the score.

It’s 90 square kilometres right to Port Philip Bay

Embracing Whitten Oval where the Bulldogs hone their play;

Includes Altona Meadows where the views are simply grand

And other lovely places now warehousing used to stand.

From Spotswood through to Tottenham employment, once serene,

Depends on heavy industry, petrochemical, marine.

The local folks are very proud, be they so rich or poor

But they all might be affected as Victoria tops the score.

It’s Inner Metropolitan (GPs’ incentives: nil –

For the local branch of the AMA this is a bitter pill).

So when a virus came along – exclusion was in vain –

The local health care services got ready for the strain.

Local people everywhere did all that they were asked

And courses sprang up all around on kissing through a mask.

A local hero came along: Gellibrander to the core

Who meant to keep the lid on it – tho’ Victoria topped the score.

This hero was a lawyer and a trusted one at that

And in the middle order for young Kevin she would bat.

She trained her loyal staffers how to listen and to scout

For useful tips, intelligence, whatever was about;

And each succeeding night they worked ’til the light it was a blur

Sometimes our hero struck a thought, sometimes a thought struck her.

’Til one day news from Mexico of which she’d hear much more

That swine flu now was all the rage – not too long from our shore.

The national plans were then rolled out – even Bishops were involved

Good health care teams and scientists all helped to have it solved.

No stone was left un-x-rayed and surveillance was maintained

And people’s sensitivity was measured when de-planed.

A hotline was established but it very soon was broke

And crackling then was all it gave to its inquiring folk.

The public mind was set at ease, there sure was nothing more

And New South Wales got uppity, as Victoria topped the score.

Victoria’s reached a thousand and some medics now complain

Even tho’ officially it’s-on ‘modified sustain’.

If children want to miss exams and have a full week off

They simply visit Gellibrand and then begin to cough.

We all will do whate’er we can to try to keep the peace

We’ll quit the smokes and exercise ’gin morbidly obese.

This gentle flu, still not a swine, in countries seventy four

And here it’s still Victoria that easy tops the score.

This illness from the Mexicans is causing a to-do

And now is a pandemic if you credit you-know-WHO.

But guided safely as we are from right the very top

We’re confident that this will pass, it’s likely soon to stop.

So raise a glass – or a long pipette – to our Gellibrander boss

‘Cos even tho it’s not too strong it makes us all la-cross.

And there may well be an upside – tho’ it’s touchy this to broach

For you won’t catch a cold at all just now if your shares are still with Roche.

So let’s consign to history, make part of national lore

The time when, quite unwillingly, Victoria topped the score.

Ovid in a time of COVID: 19 timely quotes from the Roman poet – with dedications as appropriate.

1. Dedicated to people in ‘lockdown’ – wherever they are.

Dolor hic tibi proderit oli.

Be patient and tough; some day this pain will be useful to you.

2. Dedicated to antiviral drug and vaccine researchers:

Mille sint mali mille salutis erunt.

There are a thousand forms of evil; there will be a thousand remedies.

3. For those in public health agencies:

Qui non est hodie cras minus aptus erit.

He who is not prepared today will be less so tomorrow.

4. For Dan Andrews:

Requiescendum; dat ager uberrimam segetem requievit.

Take rest; a field that has rested gives a bountiful crop.

5. For Treasurers and managers of science agencies:

Principiis obsta; sero medicina paratur
Cum mala per longas convaluere moras.

Resist beginnings; the remedy comes too late when the disease has gained strength by long delays.

6. For everyone:

Qui nolet fieri desidiosus, amet!

Let the Man who does not wish to be idle fall in Love!

7. For researchers of the effectiveness of lockdown:

Nil adsuetudine maius.

Nothing is stronger than habit.

Nothing is more powerful than custom.

8. -and another:

Quod male fers, adsuesce, feres bene.

Habit makes all things bearable.

9. For children:

Casus ubique valet; semper tibi pendeat hamus
Quo minime credas gurgite, piscis erit.

Chance is always powerful. Let your hook always be cast; in the pool where you least expect it, there will be fish.

10. For Albo:

Medio tutissimus ibis.

You will be safest in the middle.

You will go most safely by the middle way.

11. For social media enthusiasts:

Causa latet, vis est notissima

The cause is hidden; the effect is visible to all.

12. For Joe Biden:

Fas est et ab hoste doceri.

It is right to learn even from an enemy.

We can learn even from our enemies.

13. For Barnaby:

Quod licet ingratum est. Quod non licet acrius urit.

We take no pleasure in permitted joys.
But what’s forbidden is more keenly sought.

14. For cultural warriors:

Nam genus et proavos et quae non fecimus ipsi,
Vix ea nostra voco.

For those things which were done either by our fathers, or ancestors, and in which we ourselves had no share, we can scarcely call our own.

15. For Scomo and Paul Fletcher:

Et ignotas animum dimittit in artes.

And he turned his mind to unknown arts.

16. For BLM:

Gutta cavat lapidem

Dripping water hollows out stone, not through force but through persistence.

17. For people of hope and good will:

Omnia mutantur, nihil interit

Everything changes, nothing perishes.

18. For Dan Tehan, Minister for Education:

Adde quod ingenuas didicisse fideliter artes
emollit mores nec sinit esse feros.

Note too that a faithful study of the liberal arts humanizes character and permits it not to be cruel.

19. For realists everywhere:

Laudent ceteri olim; ego sum laetus ego eram natus est in illis.

Let others praise ancient times; I am glad I was born in these.

[Source of quotes: https://en.wikiquote.org/wiki/Ovid]