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Review 1: "Can a Vaccine-led Approach End the NSW Outbreak in 100 days, or at least Substantially Reduce Morbidity and Mortality?"

Published onJul 27, 2022
Review 1: "Can a Vaccine-led Approach End the NSW Outbreak in 100 days, or at least Substantially Reduce Morbidity and Mortality?"
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key-enterThis Pub is a Review of
Can a vaccine-led approach end the NSW outbreak in 100 days, or at least substantially reduce morbidity and mortality?

Abstract Background and Aims The New South Wales (NSW) COVID-19 outbreak is at 478 daily cases on August 16, 2021. Our aims were to: 1) estimate the time required to reach ≤5 cases per day under three lockdown strengths (weak, moderate, strong), and four vaccination rollouts: (a) per the original plan, (b) prioritizing essential workers, (c) b plus rapid vaccination of 25% of <60-year-olds with AstraZeneca (AZ25), and (d) b plus rapid vaccination of 50% of <60-year-olds with AstraZeneca (AZ50). 2) estimate the number of cases, hospitalizations, and deaths in the 100 days after 1/August for the 12 scenarios. Methods An agent-based model was adapted to NSW and the Delta variant. Hospitalization and mortality rates for unvaccinated COVID-19 infections were doubled given the virulence of Delta. Results The business-as-usual rollout fully vaccinates 50%, 70% and 80% of >16-year-olds by 10/Oct, 21/Nov, and 28/Dec, respectively. This reduced to 1/Oct, 30/Oct, and 22/Nov for the fastest (AZ50) rollout. A strong lockdown with a rapid vaccine rollout was the fastest to reach ≤5 cases (14-day average), with a median of 78 days (90% Uncertainty interval 61 - 103) or 18/Oct, compared to 207 days (166 - 254) or 24/Feb for a weak lockdown with no rollout acceleration. Increased lockdown strength had more impact than rollout acceleration. Under the AZ25 vaccination scenario, there were 1,440 (90% UI 262 - 10,600 deaths in the first 100 days of cases under a weak lockdown, compared to 71 (90% UI 26 - 178) under a strong lockdown scenario. Conclusion NSW will likely achieve 70% vaccination of >16-year-olds before reaching ≤5 daily cases. Accelerating the vaccine rollout is important for the medium-term, but in the short-term increased restriction strength was more effective at reducing caseload (and subsequently mortality and hospitalisation) than accelerating the vaccine rollout.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.



Social responsibility is a context of ethical issues, which suggests that an entity must act for the benefit of society at large. Such commitment is formal because it should not force entities but providing a rationale to improve the acceptance of restrictions of freedom. Social responsibility represents a duty every person has to accomplish to balance the economy and the ecosystems. This responsibility can be passive, by avoiding engaging in socially destructive acts, or active, by executing activities that directly expand social goals. Social responsibility has an essential premise that must be intergenerational. The authors of this manuscript pose relevant questions and solutions for the current pandemic in Australia. The Delta-variant COVID-19 outbreak is imposing on Australians. Despite the increased infectivity and virulence of the Delta-variant, little contemporaneous mathematical modelling seems to take place. The authors, therefore, model several restrictions and vaccination scenarios. In the “new” NSW model, the Australian colleagues consider achieving 70% vaccination of >16-year-olds before daily cases are less or equal to 5. An increase of lockdown strength may be more effective at reducing patients than accelerating the vaccine rollout. Although the modelling is applicable mental health issues need to be taken into consideration.

Vaccines and vaccination have been on the media attention for several decades with credits and discredit. Diatribes are jeopardizing some of the significant achievements in healthcare, unfortunately. Non-motivated vaccine hesitancy, program delay, and vaccine refusal are overshadowing healthcare front news. In the pre-COVID-19 era, there are numerous events illustrating a dramatic increase of exanthemata in the last few years across the globe. Vaccine hesitancy may be due to safety anxieties, low confidence in the manufacture of vaccines, and acceptability of specific approvals. Physicians, parents, and anti-vaccine groups are not able to communicate correctly in the last few years. Miscommunication has been magnified during the current COVID-19 pandemic. An increase of such preventable diseases in territories where these diseases seemed to be contained has characterized the headlines of both social media and professional platforms. New waves and new variants are on the front. The argumentation that our immune system can fight diseases is affected by the relatively weaker immune response of the individuals of today compared with individuals of more than a hundred years ago. Family physicians have a responsibility to explain to parents and families that vaccines not only benefit their health status but other individuals’ health status as well, particularly if we want to stop this pandemic quickly.


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