Requiring three doses for full Covid vaccination would “send a clear signal that it is essential, rather than simply a matter of choice and personal responsibility”, a member of a World Health Organization advisory group said.
Though the national cabinet is still awaiting advice from Australia’s independent expert group on vaccination, Atagi, as to whether people should only be considered fully vaccinated against Covid after three doses, the Victorian premier, Daniel Andrews, had been pre-empting Atagi’s advice.
“International evidence, our own experience, the views of experts and hopefully the confirmation of both Atagi and national cabinet later today will mean that everyone knows and understands that this is a three-dose project,” he said on Thursday.
Given Atagi is yet to release its advice, the matter was not settled at a meeting of the national cabinet later that day.
But on Friday the New South Wales premier, Dominic Perrottet, backed Andrews, saying he thought the proposal “makes sense”, and that even without a decision by the national cabinet three doses should be required to be “up to date” with vaccination.
“We’re waiting on advice federally in respect of whether or not it would be deemed that three doses would equal a determination of being fully vaccinated,” he said. “In the interim, I mean, we can’t say it enough: get boosted. We would say that in order to be up to date with your vaccination. You need to have three doses.”
South Australian premier Steven Marshall also said this week it was “increasingly likely” that people would need a third dose to be considered fully vaccinated. His government has already mandated the booster jab for workers including those in healthcare, aged care, and people with disabilities.
On Friday afternoon, the Northern Territory announced boosters would be mandated for workers in public-facing roles, with an 11 March deadline for high-risk workers.
Queensland University of Technology’s Prof Ross Gordon, who is part of the WHO’s technical advisory group on behavioural insights and sciences for health, said research had shown receiving a third dose significantly reduces the risk of catching, becoming seriously ill from and dying from the Omicron variant, compared with only two doses.
“Due to Omicron showing some level of vaccine evasion, there has been a move around the world towards considering a minimum of three doses as being required,” he told Guardian Australia.
“Given that Australia is in the middle of a large wave of Omicron infections – promoting third-dose vaccinations is important to protect public health and to mitigate the worst effects of this wave.”
Booster uptake has been slow in Australia, with a Guardian Australia analysis showing it could take well into 2022 to hit an 80% booster vaccination rate, with the booster rollout currently ranking almost last out of 70 countries.
But there are also challenges to mandating a third dose, such as considering timing and a deadline for when it should be required, ensuring access and what it will mean for international travellers coming from countries where boosters are not required.
If a third dose is mandated, Gordon said, it will be crucial to make it easy to get done. Wide availability and easy access, a simple and effective booking system, and a good experience when getting vaccinated will be critical to any mandate, he said.
“From a behavioural sciences perspective, behaviour change only comes about if people are motivated, if there are strong social norms and available social support, and if there is an enabling environment,” Gordon said.
“This is where mandating third-dose vaccination comes in. If there is no mandate, there is a risk that some people will consider the third dose not really that important – and therefore decide not to get it.
“We need to motivate people to get the third dose by reminding them that Omicron can still have serious public health implications not only for yourself but for others in our community – especially older people, people with underlying health conditions, which is a large share of our population.”
Andrews said a reason for his calling for a mandate was that “we would not have got to 93% double dose” without a mandate.
However, Gordon said the WHO is concerned that rich countries are pushing ahead with boosters without addressing vaccine inequity around the world. Fewer than 10% of Africans are fully vaccinated.
“So, while rolling out third-dose vaccinations in Australia is important, we need to do more at a global level to vaccinate the world, save more lives and also reduce the opportunity for the virus to further mutate.”
Dr Stuart Turville, an associate professor in the immunovirology and pathogenesis program at the University of NSW’s Kirby Institute, said any change to vaccination requirements must be led by health and science experts, and not by political parties.
The experts that formed Atagi “are brought on panels for a reason”, he said.
“It is the collective knowledge that brings this to the table. We need to learn from what we did during the HIV response. We need a bipartisan political approach, to listen to the experts and the most important thing to do is engage the community along the way.”
Professor Dominic Dwyer, the director of public health pathology in NSW who was among international experts who travelled to Wuhan last year for the WHO investigation into the origins of coronavirus, said while booster shots were important, he was “not sure there is clear evidence to say a booster should be included as part of the ‘fully vaxxed’ definition” for everyone.
“It’s important for all to have a booster, but it is a political decision as to whether it should be mandated,” he said.
