There was no argument inside national cabinet about Morrison’s AstraZeneca advice because he didn’t flag it

Before the public brawling on Wednesday there was the relative calm of Monday night when leaders gathered virtually for an emergency national cabinet meeting. Scott Morrison dialled in from the Lodge where he’s been in quarantine.

Lt Gen John Frewen – brought in to reboot Australia’s sluggish vaccination rollout – was online from Parliament House, accompanied by the health department secretary, Prof Brendan Murphy, the chief medical officer, Prof Paul Kelly, and Morrison’s department head, Phil Gaetjens. State and territory leaders battling outbreaks of Covid-19 joined from their jurisdictions.

Given the current risks, the sluggish vaccination rollout was front and centre in the discussion. Because Pfizer stocks are running low, there were questions about when additional supply would be available. Some batches of AstraZeneca are also about to hit their use-by dates. The New South Wales premier, Gladys Berejiklian, said the whole inoculation infrastructure needed to gear up significantly before the arrival of new Pfizer doses later in the year – a point she has been making publicly.

According to people familiar with the deliberation, Frewen told the leaders there were 290,000 doses of AstraZeneca currently available. The Western Australian premier, Mark McGowan, expressed frustration about having to constantly explain conflicting health advice about the AstraZeneca vaccine. The leaders then discussed whether Australia should, in essence, cut its losses, and export the current AstraZeneca stock to the Pacific and the region. But this idea was dismissed.

As AstraZeneca was discussed, Morrison also advised the state and territory leaders Canberra would create a professional indemnity scheme for GPs administering the vaccine. But Morrison did not tell the premiers and chief ministers (certainly not explicitly) that he was also going to telegraph expanding access to AstraZeneca for people under 40.

This particular thunderbolt emerged when Clare Armstrong from the Daily Telegraph asked the prime minister whether the proposed indemnity scheme meant people under 40 would be able to get the jab. Morrison answered by saying: “Well, if they wish to go and speak to their doctor and have access to the AstraZeneca vaccine, they can do so.”

Armstrong persisted: “In any age group?”

Morrison: “So, the answer is yes, they can go and do that.”

So state and territory leaders found out about expanded access when they watched Morrison’s press conference after national cabinet on Monday night. So did Australia’s medical fraternity. GP clinics would be inundated with queries from the public the next day but no advance warning was given.

The scramble to understand what on earth had just happened then cascaded into Tuesday.

The premiers began to distance themselves from Morrison’s comments over the course of the day. On Tuesday, Gaetjens met virtually with his counterparts in the states in the first secretaries group. Berejiklian’s department head, Tim Reardon, asked Morrison’s departmental head for clarification about how this new position aligned with the expert advice. Gaetjens replied by suggesting the media had blown Morrison’s remarks out of all proportion.

To understand why AstraZeneca access is a significant flashpoint, we need to roll back to 9 April. Within the confines of the national cabinet, the precise cut-off point for AstraZeneca eligibility has been a point of some sensitivity.

At a national cabinet meeting on 9 April, there was a discussion about whether or not it was safe to give that vaccine to people aged between 50 and 59. A number of state and territory leaders asked questions about where the cut-off between Pfizer and AstraZeneca should be.

But the Queensland premier, Annastacia Palaszczuk, was particularly exercised, because her chief health adviser, Dr Jeannette Young, was concerned about the risks for people aged under 60. Palaszczuk was unhappy the advice at that time was AstraZeneca be the preferred jab for people over 50. She cited publicly available advice from the Therapeutic Goods Administration about blood clots found in other jurisdictions in women under 60.

But the national cabinet stuck with 50 as the cut-off because that was the recommendation from the Australian Technical Advisory Group on Immunisation (Atagi). But in the middle of June, the advice from Atagi changed, and the cut-off point was moved to 60.

With that bit of background in mind, you can see there would have been an almighty brawl in national cabinet on Monday night had Morrison flagged expanded access for the under-40s. If the prime minister had signalled his thinking explicitly, some of the state and territory leaders would have also sought urgent clarification about whether or not the indemnity arrangements for GPs were going to be extended to nurses working in the mass vaccination hubs run by the states.

But people insist there was no argument, and no wide-ranging discussion about the practical limits of the indemnity, because Morrison didn’t tell state and territory leaders what he was going to say.

Then came Wednesday’s explosion. Instead of a dispute contained within the confines of the national cabinet about whether the prime minister should be encouraging young people to get AstraZeneca, Australians have now witnessed a visceral public brawl between the levels of government.

Before unpacking that brawl it’s worth doing a quick stocktake on the medical advice. It’s nuanced. The states are correct to say the current Atagi advice is that Pfizer (not AstraZeneca) is the preferred vaccine for Australians aged between 16 and 60.

But the advice also creates room for informed consent. It states that AstraZeneca can be used in adults under 60 (when Pfizer is not available) when the benefits “are likely to outweigh the risks for that individual” and the person has “made an informed decision based on an understanding of the risks and benefits”.

On Wednesday, Queensland – which is obviously under some political pressure about its handling of the local outbreak – did what is often popular in a parochial state. The premier deliberately picked a fight with Morrison.

The fight was staged but it certainly wasn’t confected.

The premier and the chief health officer just said publicly what they’ve been saying privately since April. Young told Queenslanders under 40 not to get AstraZeneca. Her comments could not have been more direct or stark. “I don’t want an 18-year-old in Queensland dying from a clotting illness who, if they got Covid, probably wouldn’t die,” Young said.

The other states were more diplomatic than the Queenslanders, but premiers, either implicitly or explicitly, lined up solidly behind the Atagi advice over the course of Wednesday rather than behind Morrison’s Monday night signalling. The default in Australia throughout this pandemic has been risk aversion.

The chaotic events since Monday night invite several questions. There has been some speculation that Morrison made up expanding AstraZeneca access on the spot; that he mis-spoke somehow. But people at the state level don’t think this was a prime ministerial improvisation and work on the indemnity scheme underpinning it predated Monday night’s deliberation.

People locked down in Australia’s major cities, watching the brawling between the levels of government on Tuesday and Wednesday, will likely be asking themselves why the national consensus broke down now in such spectacular fashion?

The answer to this question is complicated but the following things can be observed. The rules of engagement in the pandemic shifted significantly at the end of May when the Victorian government decided to publicly shirtfront Morrison over bungling the national vaccination rollout. This marks the point at which the states lost their appetite for gritted teeth diplomacy.

But if we look closely at what has been happening in recent weeks, we can also observe Morrison’s frustration levels building. When it comes to managing outbreaks, the states remain risk-averse, particularly in an environment when not enough Australians are vaccinated. That creates constant friction between the jurisdictions, given vaccine supply is a commonwealth issue.

While the states continue to vent about the vaccination rollout being a public policy botch-up of epic proportions, Morrison, in a planning sense, has been attempting to push past the crisis – driving work at the officials level which will attempt to set new benchmarks about what living with Covid looks like in Australia. That work will likely surface in the coming weeks.

Morrison’s frustration with the consensus-driven health advice he gets has been on display more frequently – and some of that frustration may well be justified. Politicians need the guidance of experts but the community also needs political leaders capable of weighing all the variables and arriving at an on-balance decision.

But here’s what the public does not need: exhibitions of transient cat kicking, or proxy battles over whether health advice is mandatory or optional, or seminars about which particular bits of the health advice might be more important to listen to.

The public needs political leaders to put their interests first and be competent in a crisis. That’s the long and the short of it – and the past 72 hours has not inspired confidence.

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