When Covid-19 first arrived on Australia’s shores forcing residents into their first ever lockdown, many thought restrictions would last a few weeks.
Most never envisioned they’d still be dealing with lockdowns, restrictions, mask wearing and travelling bans more than a year later.
The lightning-fast development of effective vaccines last year raised hopes people would soon be able to transition to a more normal life, but a slow vaccine rollout in Australia and the emergence of more infectious covid strains like the Delta variant has led to further delays.
So when can Australians expect life to go back to normal?
Variants make it harder to achieve herd immunity
One of the key pathways back to normal depends on the population achieving herd immunity.
This requires a certain amount of the population to either get the virus or to be protected via vaccination so they are less likely to get the disease or to pass it on if they have already been infected.
Initially it was thought herd immunity could be achieved with as little as 70 per cent of the population vaccinated but the variants, particularly the Delta variant, has changed this.
University of NSW Professor Mary-Louise McLaws, who is an adviser to the World Health Organisation (WHO), said the Delta variant is almost twice as likely to be passed on to household family members.
“That’s a really big increase in transmissibility for secondary infections,” she said.
Prior to the emergence of the variants, Prof McLaws estimated that around 85 per cent of adults in Australia would need to be vaccinated for herd immunity.
The higher infectiousness of Delta means vaccination rates would need to be around 100 per cent among older people receiving the AstraZeneca jab, and about 70 per cent of those who got Pfizer.
Prof McLaws believes children over 11 or 12 years old should be included in the vaccination program, to make it easier to achieve herd immunity.
If children were included, it would bring down the proportion of the adult population who would need to be vaccinated to about 70 per cent. However, Prof McLaws still believes it’s better to aim for around 85 per cent to be safe.
Deakin University Professor Catherine Bennett said not everyone will want to be vaccinated and this may be fine if they are spread out in the community, but if there were significant pockets of people living in a certain area, or working in a particular occupation, this could be more of a problem as they would be connected and could spread the virus to each other.
“If the virus gets into that setting, you could have enough unvaccinated people for it to take off,” she said.
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Vaccines still work but you need two doses
One of the reasons why the Delta variant is causing experts to worry, is that the current vaccines are not as effective at protecting against symptomatic disease, especially if you’ve only had one dose.
According to figures from Public Health England published in a preprint paper this week, four weeks after one jab of the Pfizer vaccine, 36 per cent had protection against Delta, which is lower than the 50 per cent protection it provides against the Alpha variant.
For AstraZeneca, protection dropped to 30 per cent.
However, two weeks after two doses of Pfizer, this increased to 88 per cent. For AstraZeneca protection increased to 67 per cent.
Importantly, both vaccines were also highly effective at preventing hospitalisation after two doses, with Pfizer 96 per cent effective, and AstraZeneca 92 per cent effective.
The results point to how crucial it is for all Australians to be fully vaccinated with both doses of a vaccine.
Originally the Morrison Government expected all adults to be able to access two doses by the end of the year, but delays with the rollout suggest many people won’t be able to have their second dose until early next year.
Everyone around the world needs access
Even if rich countries like Australia vaccinate their populations, they are still susceptible to vaccine-resistant mutations emerging from other countries that aren’t vaccinated.
In order to combat this, the World Health Organisation has called on rich countries to contribute to a massive effort to vaccinate at least 10 per cent of the population in all countries by September, and at least 30 per cent by the end of the year.
This will require an extra 250 million vaccine doses by September, with 100 million needed in June and July alone.
The Covax program, which is aimed at procuring enough vaccines for 30 per cent of the population in 91 of the poorest participating territories, is already 200 million doses behind where it hoped to be at this point.
One of the major problems is global vaccine manufacturing capacity is simply not big enough to end the pandemic quickly.
Australia has experienced first-hand the problems with securing promised vaccine doses from overseas.
Last month, leading pharmaceutical industry groups based in Europe and the United States said an estimated 11 billion vaccine doses could be produced by the end of 2021.
Some suggest intellectual property rights should be lifted on vaccines but other argue this would do nothing to help as ingredients were sometimes scarce.
How much longer do we have to wait?
In Australia, many are lucky enough to live a fairly normal life but residents are still subject to lockdowns, interstate travel disruptions, overseas travel bans (unless an exemption is given) and can face delays returning home followed by a lengthy and expensive quarantine period.
Prof Bennett said Australia would be able to take the next steps towards a more normal life once everyone had access to the vaccine.
“If this is achieved sooner maybe it will be earlier than next year,” she said.
Much of this will depend on how the virus is managed overseas.
“We may be there by the middle of next year if there is sufficient vaccination but there might be steps before then, or after,” she said.
“It depends on what happens in the rest of the world and with variants.”
Prof Bennett said the world was actually in a better position than expected as effective vaccines had been developed very quickly.
“But we’ve trapped ourselves because we’ve got caught up in the notion of zero tolerance,” Prof Bennett said.
“We are long overdue to have a conversation on how to transition from zero tolerance to a vaccinated world.”
Infectious diseases expert Professor Peter Collignon of Australian National University believes Australia and the world will be dealing with the coronavirus for a couple of years at least.
“Because it has spread around the world and in some animals,” he said.
“We’re not going to eradicate this but we can decrease the risk as much as is reasonable to stop the spread.”
Prof Collignon believes quarantine will probably remain in place for another year or more, but those who are vaccinated and are coming from a low prevalence country may be able to quarantine at home.
“If you are unvaccinated and coming from a high prevalence country, you will probably still have two weeks of supervised quarantine,” he said.
He said the biggest dilemma for Australia would be what happens in big countries like the United States and Canada during their next winter (at the end of this year).
This will show how much the spread of the virus can be controlled.
“I think over the next year we will still have to live with limitations on crowds indoors, indoor mask wearing and those who are sick will still have to stay away from work.
“I think it’s going to be a gradual change, we’re not going to just go back to 2018.
“Some restrictions may vary based on how much vaccination there is and possibly the season.”
‘We have to adjust our tolerance’
Prof Bennett believes authorities need to develop a stepped process so people can understand what the path out of restrictions looks like, and what the risks and benefits are of each level.
“What is certain is that we can’t stay where we are,” she said.
“We have to adjust our tolerance towards the virus.
“Some people say that we’re saying it’s OK for people to die but the reality is, people die of many things,” she said.
“Even mild infections can still kill people.”
Prof Collignon agreed, pointing out that 1200 had died with the flu in 2017.
“Every winter we do have a large number of older people over 80 years old, who die with or from respiratory tract infections,” he said.
“When we have a higher uptake of vaccinations, even if covid is in the community, it should not cause more deaths than those from the flu in a normal season, and we can also take measures to decrease the spread,” he said.
He said covid vaccines were about 90 per cent effective at stopping hospitalisation even for the Delta variant, while the flu vaccine was only between 30 to 50 per cent effective at best.
“The covid vaccines are two or three times better than the flu vaccine, for a disease that has a 20 to 30 higher mortality rate.”
What does ‘living with the virus’ look like?
Assuming the virus can be contained globally and there aren’t local outbreaks of variants of concern, Prof Bennett believes “living with the virus” could see authorities treating the coronavirus as another notifiable disease.
There is already monitoring done for the flu every year, with GPs testing some patients who get sick to see what strain they have.
Prof Bennett believes this type of sentinel surveillance could potentially be done for the coronavirus.
Random routine testing could also be done among certain professions including frontline workers and those who work in aged care or cancer wards, to keep an eye on what is happening in the community.
“It won’t be about finding every case but having a finger on the pulse of what’s going on,” Prof Bennett said.
“It’s about understanding what variants are circulating, and the appearance of any vaccine breakthroughs at higher levels than you would expect.”
Quarantine restrictions could also be eased so that unvaccinated people who come into Australia from countries with low levels of the virus circulating, could quarantine at home, possibly for a shorter period of time if they test negative, rather than having to complete 14 days in a supervised hotel.
Prof Bennett said only people who had variants of concern may be required to quarantine in hotels, while others may be able to do so at home.
She said Australia can’t remain in a “holding pattern” forever.
“We’ve worked so hard to prevent deaths and I think that is still our goal but at some point a pandemic becomes endemic,” she said.
“This is when we stop reporting every case or every hospitalisation.”
However, if authorities and Australians in the community are not willing to accept some level of risk, there could still be lockdowns and travel bans on certain countries for a long time to come.