Health Department knew of vaccine rollout risks but did nothing to address them

The rollout of COVID vaccines to residential aged care and disability care facilities was botched due to problems the federal Department of Health knew about in advance but failed to address, the auditor-general found in a review of the Morrison government’s disastrous vaccine rollout.

The vaccination of Australia’s residential aged care and disability care populations, ostensibly a priority of the government’s vaccination rollout, occurred far behind not merely initial but revised target dates, with Australians in residential disability care not being vaccinated any faster than other Australians by the end of 2021.

According to the ANAO’s examination of the vaccine rollout, the aged care delivery program was harmed by the poor performance of outsourced vaccine providers, who struggled to properly communicate with aged care facilities, failed to employ enough staff and underperformed in their delivery. But Health also relied too heavily on just two providers, who were also engaged to deliver to the much more diffused residential disability care sector.

In fact the rollout planned for the disability sector was hobbled from the very beginning. The Department of Health engaged Aspen Medical to “co-design” that rollout, but didn’t do so until February 19 last year. Despite consultations with the sector being rapidly undertaken that month, design wasn’t completed until March, by which time the rollout was already underway. Health thought the rollout could be done by just one provider, then had to go to another in May when the rollout proved far too slow. And Health decided aged care facilities were the priority, so directed the efforts of its contractors there anyway.

The residential disability care sector was always going to be far more difficult, as it operated across a far larger number of small sites and the data problems that plagued the aged care rollout were magnified. And Health knew the problems ahead of time. “Most of these issues were identified as risks during the joint planning process undertaken by Health in February 2021 with one of the VAS providers,” the ANAO found. “However, they were not adequately addressed, which impacted the speed of the rollout of vaccines to residential disability facility residents.”

In some ways worse, Health wasn’t fully sure of its data on the progress of the rollout. Health claimed to have met its adjusted rollout target of the end of October for the sector, but ANAO says “due to the poor quality of the data provided the ANAO was not able to make an independent assessment of this”. Again, data was outsourced by Health — and with that came significant risks:

Health has outsourced the data collection and IT management for systems used in the vaccine rollout to other parties, including: Services Australia (AIR); Salesforce (VAS and CVAS); Accenture (reporting dashboards); and Amazon Web Services (CVAS). Health is responsible under various Acts for the confidentiality, privacy and security of the data collected using these systems and cannot outsource these responsibilities. Health does not have assurance that third parties have IT controls in place to ensure the confidentiality, integrity and availability of data Health relies on point of time assessments, contractual obligations and management statements from entities. These are not sufficient to demonstrate that IT controls have been implemented and were operating effectively over the vaccine rollout.

The giant Commonwealth Health department runs no hospitals and provides no medical services. It’s unreasonable to think it should have a permanent capacity for an emergency rollout of a vaccine to a sector containing hundreds of thousands of residents and staff. Outsourcing was always going to be necessary — but the outsourcing itself was poorly managed and undercooked, and failed to address known problems.

The unusual nature of the pandemic circumstances means the ANAO is uncustomarily circumspect in its recommendations, suggesting only that Health conduct a full review of the rollout. There are no magic solutions, even in hindsight, to the problem of a department without capacity being tasked with a significant, urgent, on-the-ground delivery process, especially if potential contractors themselves don’t have enough staff.

The issues now seem a distant memory, of a government now rightly booted out, but it has continuing implications. If another variant appears that requires the same kind of rollout, it’s entirely possible workforce shortages could lead to even worse outcomes, despite the benefit of lessons from the first time. Next time, hopefully, Health will at least have a sound information base to work from.