Australia needs a Covid plan B that gives more freedom to the vaccinated | Liz Hicks and Greg Dore
Australia finds itself at an inflection point. Prior to the emergence of effective Covid-19 vaccines, our strategy placed us as one of the most successful nations in managing the pandemic and reducing its burdens on health, lives and liberty.
To do so, we leaned into our geography and the cultural tendencies flowing from it – our historical preferences for border control as a response to complex social and geopolitical problems; our tendencies toward protectionism.
This came at a price: tens of thousands of Australian citizens and residents “stranded” abroad, and citizens and residents with lives, loved ones and ties elsewhere from which they were separated indefinitely. Arrival caps have been successively cut, but that cost has largely been supported by Australians onshore as acceptable for the benefits it delivered.
With arrivals caps almost unable to be cut further – and the current outbreak in Sydney stemming from freight crew rather than returning citizens or residents – our current strategy has nowhere else it can go.
Hubris that we managed the pandemic better than those elsewhere – Australian exceptionalism – drove a lack of vaccine urgency. That extended to a concerted campaign in some quarters to undermine confidence in an effective vaccine upon which our neighbours, and those who look to us for leadership, will rely.
The capacity for high-level testing and contact tracing to control transmission once community spread is established is diminished, regardless of how well resourced those teams are. Cities across Australia, including Melbourne, are likely to spend further time in lockdown, for longer durations, until high levels of vaccination are reached.
Delta has altered the viability of Australia’s current strategy. Continuing a one-size-fits-all approach to risk that does not differentiate its restrictions on rights according to vaccination status will inflict more pain on the Australian community than necessary to control the current outbreak. Australia needs a plan B.
The capacity for Covid-19 vaccination to enable greater freedoms in the short term needs to be fully harnessed. Individuals should have freedoms restored to them once they are fully vaccinated – including the ability for vaccinated citizens and residents to leave Australia without an exemption, and on return home quarantine without being counted toward the caps.
Australia can also look to international examples where vaccination passports have been used prior to the completion of the vaccination rollout to minimise the impact of necessary lockdowns upon individual civilians.
In Germany, for instance, a constitutional argument was used to support the introduction of “vaccination privileges” despite the inequality this produced at a time when younger age groups were not eligible.
Freedoms from certain restrictions are permissible on the basis that blanket restrictions on rights across the community should not be a new “status quo”: any restriction on an individual’s rights should only continue for as long as absolutely necessary.
This logic justified allowing fully vaccinated individuals additional freedoms notwithstanding that full vaccination does not provide complete sterilising immunity.
Society as a whole benefits from such an approach, as individuals do not need to wait before a critical mass is vaccinated before they can benefit. Additional freedoms for the vaccinated accordingly incentivises vaccine uptake in the shorter-term.
In the medium-term – even prior to the completion of the rollout – Australian governments could consider exemptions for the fully vaccinated from internal border closures and restrictions of movement within jurisdictions.
They could ease restrictions on visiting loved ones in aged care or hospitals – settings where lockdowns have the greatest impact on human contact and freedom.
Restrictions from lockdown for hospitality where staff and patrons are fully vaccinated, or for larger sporting events, could also be considered.
Australians stare down the barrel of months of restrictions and cyclical lockdowns – not confined to Sydney – before high levels of community vaccination are achieved.
Vaccination need not be a light at the end of the tunnel. It can be incorporated, now, as a means of limiting the impact of necessary restrictions on individual rights.
Right now in Sydney tens of thousands of people are isolating at home following potential exposure to Covid-19.
Outbreak control relies on high compliance with public health orders, and evidence indicates the vast majority of the community is cooperating. In Sydney, more than 2,000 people are in home isolation with active Delta infection, and all evidence suggests they are complying.
Our recent evaluation of NSW positive cases in hotel quarantine suggests among fully vaccinated the number of positive cases would be 6-12/10,000 international returnees – a drop in the ocean of current Delta infection. Thus, NSW could immediately allow more fully vaccinated returnees to enter home quarantine, without counting those persons to the 1,500 persons per week cap, with negligible risk of greater community spread.
Innovative screening strategies such as self-collected daily rapid antigen tests could be incorporated into the home quarantine model. Given such an exceedingly low-risk scenario, a home quarantine trial simply delays implementation of a sensible public health measure that would provide an avenue for thousands of stranded Australians, and a model for enhancing freedom of movement.
Such a home quarantine model would also enable Australia to enhance freedom of movement by allowing fully vaccinated individuals to leave without exemption, as they would also return to home quarantine. Currently, around 4,000 travel exemptions per week are granted for Australians to travel abroad, with a majority leaving for more than three months.
A doubling or trebling of this number through such a program again would not place added pressure on the hotel quarantine system and would be an important step along a pathway of opening up that will be accelerated once high population vaccine coverage is achieved.
These suggested programs to enhance freedom of movement across our international border honour Australia’s commitments under international human rights law.
Australia is currently responding to a complaint against it before the United Nations Human Rights Committee that argues we have breached the right to re-enter one’s country. As Jane McAdam and Regina Jefferies’s recent research highlights, the framers of the international covenant on civil and political rights clearly never intended for citizens to be excluded on health grounds.
Within this framework, the recent halving of flight caps without a consideration of the vaccination status of arrivals is disproportionate.
That many parts of the world move forward while Australia locks down is not solely because of a delayed vaccination rollout: it stems partly from a refusal to let go of a one-size-fits-all model of managing risk that disregards vaccination status and belongs to a different time, and an attachment to the security and glory that time delivered.
Australia’s recent halving of arrival caps, with no alternative arrangement for the fully vaccinated, lacks proportionality and disregards international human rights norms to which we are committed.
The emergence of Delta provides an opportunity to acknowledge the limits of our existing approach, incentivise vaccination and innovate low-risk home quarantine to meet societal and human rights goals.
Liz Hicks is a PhD / Dr iur candidate in constitutional law at the University of Melbourne and Humboldt University of Berlin
Greg Dore is an infectious disease physician and epidemiologist at Kirby Institute at UNSW Sydney