The federal election campaign is “clearly a case of Covid Fight Club,” says Prof. Stuart Turville. “Don’t talk about it.”

Turville, a virologist at the University of New South Wales, wonders when Australia’s continued Covid-19 deaths and slowing booster rates “will become a topic of discussion within our government”.

There have been nearly 7,900 Covid deaths in Australia since the pandemic began, with at least 66 on Tuesday alone and a further 53 on Wednesday. More than 1,000 deaths were reported in the past month.

Meanwhile, otherwise healthy people are reporting triple-dose coronavirus symptoms so significant they require days of bed rest as hospitals and the broader healthcare system collapse not only from infected staff but also from years of under-resources and under-funding. And many Australians are still wondering if they will eventually need a fourth dose of a Covid vaccine, or if existing vaccines will be tweaked to better respond to new variants.

Current vaccines are extremely effective in their primary job: preventing people from developing serious illnesses and being hospitalized. But Covid infection rates are rising in Australia, raising particular concern for immunocompromised and other vulnerable people who are less protected by the vaccines.

The number of people receiving their vaccine booster doses is slowing: around 19.7 million Australians aged 16 and over are receiving a double dose, compared with around 13.6 million who have received three or more doses.

None of the major parties announced policies or new funding for vaccinations or the long-term effects of Covid ahead of the election.

“Time will tell how complacency will play out on many levels,” says Turville.

“What happens if we don’t get our third or fourth dose? Will we see the death rate go from 40 to 60 to 80 per day before we start talking about it again?

“We need to make sure those who have been working on the response to this virus stay tuned. The best way to do that is for government, as well as industry, to continue funding the response.”

“The plaster will be torn down”

Experts say the funding must include better tracking of Australia’s Covid-19 infection rates and deaths, as international comparisons have become meaningless due to wide disparities in how countries test and report cases.

It used to be easier to track the virus and compare data. Due to restrictions, only a few people were infected in Australia for a long time, so almost every case could be investigated. There were no vaccines, so researchers could determine how the immune system responded to the virus on its own. There were far fewer variants, making it clearer what a single virus strain was doing.

Turville now says “the pavement will be torn down”.

“The immunity in the community is a real mix,” he says. “It’s a mix of prior infection, then vaccination, or vaccination, then infection, or booster vaccination, then infection. It’s interesting on many levels, but also complex.”

This mix of variables also makes it more difficult to study how long protection against the virus lasts.

“Modeling a Decay [immune] The reaction now involves multiple starting points,” says Turville.

“Was it your refresher or your last Covid-19 infection?”

Small changes in the virus were tolerated by the available vaccines, which responded well to the delta and alpha variants. But then came Omicron.

“The virus entry route has changed, and in doing so, the virus has crawled into the respiratory tract,” says Turville.

“Many people become infected with Omicron after their booster vaccination. You can also transfer it easily. The fact is, we still don’t know how this immunity will evolve over time, and more importantly, what variant we will encounter in the future.”

Prof Sharon Lewin, infectious diseases doctor and director of the Doherty Institute, says what all this will mean for Australia’s vaccination program is being considered by the Australian Technical Advisory Group on Immunization (Atagi), which advises the government.

“We know from large studies, most notably Israel, that immunity to Omicron gradually wears off after the third dose, which means your protection against infection decreases,” says Lewin.

“But your protection from hospitalization is pretty good after your third dose, which is really the most important thing. Israel has shown in elderly populations aged 60+ that a fourth dose further reduces the risk of hospitalization, including Omicron.”

Atagi recommends certain groups receive a fourth dose to maximize their protection against serious illness. This includes adults 65 years and older, Aboriginal and Torres Strait Islander people over 50 years of age, residents of aged and disabled care facilities, and anyone 16 years and older who is severely immunocompromised.

“At this time, the benefit of protection from hospitalization by a fourth dose has not been demonstrated in the general population,” says Lewin. “That may change as we get more data and Atagi is actively monitoring the situation.”

Meanwhile, Prof Julie Leask of the University of Sydney Institute of Infectious Diseases says that two-dose coverage in Australia has “definitely reached a high limit” at 95.6% for people aged 16 and over.

The immunization rate of the booster shot is now 70% and the immunization rate of the double dose elementary school students is 53%. Leask believes that without ongoing vaccination campaigns and government attention, vaccination rates in these groups will only “creep slowly”.

“We need to increase our booster coverage, especially for people at highest risk of serious illness,” Leask says. “This remains urgent, especially as we head into winter.

“We also need high influenza vaccination coverage. That’s always an issue, but this time there’s more immune naivety in the population aged two and over without a major flu.”

Leask says it’s frustrating to see a lack of political urgency on these issues.

“Unfortunately, in the run-up to the election, public health seems to have gone off the radar altogether,” she says.

“The new government should urgently review our vaccination situation and plan a national campaign to remind people and persuade them to keep their vaccinations up to date. More broadly, we need to know what the major parties want to do about a pandemic review and public health workers.”

It remains unclear why so many eligible people are not getting their third booster dose, Leask says.

“Australia needs timely and routine deep dives into why people don’t vaccinate so we can target the strategies,” she said.

“Guessing people after the fact leads to inefficiency because sometimes governments assume they know and can miss the mark. When the disease comes, it’s too late. This is the biggest challenge in boosting vaccine uptake.”