A conversation is swirling in Australia, sparked by a single line in the budget papers.
The question is straightforward – how do we reopen Australia safely, in a world of COVID? – but complicated by myriad factors, both in and out of the control of governments, doctors and business leaders steering the conversation.
The federal government explicitly tied border reopenings to vaccination rates, but its rollout is far slower than hoped.
Quarantine for returning travellers may remain for “years”, but no new federal funds for state facilities came in the budget.
Prime Minister Scott Morrison is pressuring states to let vaccinated Australians skip lockdowns, but faces pushback from risk-averse premiers who wield strong public health responses.
“The issue is, when we are fully vaccinated, what risk appetite are we going to have?” said former deputy chief medical officer Nick Coatsworth.
The answer to that question is still forming. Here are the factors.
Considering rules have been explicitly linked to vaccinations, it’s the multibillion-dollar question – what percentage of Australians need a COVID jab before rules relax?
The most basic answer is, nobody can confidently say.
Vaccine trials are still running on how effective vaccines are in reducing transmission and illness.
More data is needed to make definitive calls on which rules can be relaxed, and by how much.
It’s a balancing act – as vaccines lower risk, rules can potentially be eased.
The federal government has resisted putting a number on how many vaccinations it wants before opening borders.
New South Wales Premier Gladys Berejiklian cited a figure of five million residents in her state before talking about international borders.
NSW Treasurer Dominic Perrottet wants the federal government to outline a roadmap for reopening, with specific targets on vaccinations.
“It will be a very difficult conversation to have with the Australian people,” Mr Perrottet told Radio National.
“We can sit here on the other side of the world and remain closed, or we can understand … ‘This is what success looks like’ and once we get to this point, we’ll open up the borders.”
Labor’s shadow health minister Mark Butler called for similar.
“Until we have some confidence they’re actually going to meet some of those milestones, I think it’s understandable Australians are going to be pretty reluctant to start talking about opening up borders,” Mr Butler said.
Australian Medical Association president Dr Omar Khorshid warned “at some point, it will not be possible to justify” border closures.
He said borders should open “when we have an adequate proportion” vaccinated.
Questions to the AMA on what “adequate” is, went unanswered.
Dr Coatsworth, an infectious disease specialist, wrote in the Nine newspapers “a significant majority” should be vaccinated before borders reopen.
In a Sunrise interview, he said rates of 60 to 90 per cent were needed for “COVID control within the community”, but a rate to wipe out the virus in Australia “may be unattainable”.
It is this singular question, around whether Australia will “live with the virus” or try to stamp it out absolutely, which has dogged public health conversations since March 2020.
Many epidemiologists and politicians have called for ‘zero COVID’.
As Mr Morrison has repeatedly said, Australia’s official strategy is ‘aggressive suppression’.
However, a vaccine has never quickly wiped out a virus in human history, and the current crop of COVID jabs – according to numerous epidemiologists spoken to by TND – may not have high enough efficacy rates to do so on any imminent timeframe.
Victoria’s chief health officer Brett Sutton said recently Australia may be at “a critical juncture where we need to make a call on letting it run”.
Dr Coatsworth, who was Australia’s deputy CMO during the pandemic’s early stages, said conversations about risk must be had.
“We have created this deep risk aversion to COVID-19, which will not necessarily be a valid position to base our policy when we have a majority of Australians vaccinated,” he told ABC’s Afternoon Briefing.
“Whereas if we accept there will be a degree of COVID that can be managed within the community with our health system … then that number is clearly a lot less.
“Whatever your principle is about COVID circulating in the community effectively dictates how many people will need to be vaccinated before you open the international borders.”
Mr Morrison gradually advanced discussions this week around whether vaccinated people could avoid lockdowns and restrictions.
He said he “liked” the idea of vaccine passports, where vaccinated people show their medical status and skip certain rules.
But this clashes with electorally popular lockdowns and snap health rules that state premiers have used for 14 months, which some leaders have imposed after one single case in their community.
Ms Berejiklian and Queensland Premier Annastacia Palaszczuk wanted more information about Mr Morrison’s ideas, which would need national cabinet sign-off.
The PM said the change would be the “next most achievable step”, noting other nations were running similar programs.
Proposed changes would give more confidence to people to book holidays or business trips.
It also doesn’t hurt that, as Health Minister Greg Hunt pointed out recently, it could be an “incentive” for people to get vaccinated.
Even when borders reopen, rules will likely remain for those entering Australia.
Our hotel quarantine program has been among the world’s most successful, but two dozen leaks into the community sparked mounting calls for specialised purpose-built facilities.
The states want the federal government to stump up cash; Canberra says it’s a state responsibility.
Mr Morrison and Mr Hunt stressed quarantine, of some kind, will be needed for the foreseeable future.
However, medical experts are probing whether shortened hotel stays or alternative arrangements could be used, depending on vaccine efficacy rates.
Glenn Keys, founder of Aspen Medical – helping run vaccination and quarantine programs – told Radio National quarantine will likely be needed for “years”, and said the federal government should look at expanding quarantine facilities.
Even once the borders reopen, virus measures will be with us for some time.