Australia has a world-class health care system that functioned well through the beginning of the COVID-19 pandemic, supported by lockdown measures. However, without widespread vaccinations the Delta variant has exposed and threatened the Australian health care system, undermining its overall performance during the pandemic.
Australia has a universal health care system (1). This guarantees free or low-cost access to health care services including general practitioners, medical specialists, allied health workers, and nurses to all citizens (2). This program is funded through the national tax system and government levy (1). It is jointly administered across all levels of government – federal, state and territory, and local (2). The federal government provides funding, monitors quality and efficiency of health care services, regulates the aged care sector, among other responsibilities (2). Crucially in the context of the pandemic, the federal government is also responsible for buying vaccines (2). The state governments are responsible for service delivery (1). They own and operate public hospitals, ambulances, public dental care, community health and mental health care, and administer vaccinations (1). Finally, local governments deliver community health and related programs (1). Together, this system is designed to provide high-quality and affordable health care for all Australians.
Australia’s health care system has been tested by the global pandemic. The first cases of COVID-19 in Australia were reported on 25 January 2020 (3). In response, Australia used its geography as an island continent to its advantage, closing international borders in March 2020 and requiring all arrivals to quarantine (4). When the virus inevitably entered the population, various lockdown measures were introduced where outbreaks occurred. Of note was the extended lockdown in Victoria beginning in June 2020, as the COVID-19 outbreak there justified the declaration of a “state of disaster” (4). This included the imposition of a nightly curfew, mandatory face coverings, and forced closure of schools and businesses (4). By October 2020 Victoria had no new cases of the virus and the lockdown measures were progressively lifted. This strategy was proven to work: in November 2020 a small outbreak in Adelaide was contained by a five-day lockdown (4).
The messaging was clear: Australia needed to act collectively to protect our population and our health care system. Restrictions were justified in terms of protecting vulnerable Australians and ensuring that the health care system was not overwhelmed. This accords with our universal health care system: health care is characterised as a collective goal for all Australians. We were all expected to adhere to lockdown restrictions, regardless of our individual risk appetite or health vulnerabilities.
The strategy of suppressing COVID-19 was broadly successful. Between September 2020 and July 2021 we averaged less than 40 new confirmed cases of COVID daily, and no deaths (5). Our health care system had remained robust. However, Australia had missed a key piece of the puzzle. Although a safe and effective vaccine had been developed in early 2022, only 26.31% of the population was fully vaccinated by August 2021 (6). This placed Australia 35th of the 38 OECD countries per percentage of the population that have received two doses of COVID-19 vaccine (6). This was a crucial failure of the health care system. The federal government had failed to buy adequate supplies of the vaccine for the Australian population.
This failure was exacerbated by the arrival of the highly transmissible Delta variant in New South Wales (NSW) in June 2021 (7). The NSW government took 10 days to impose lockdown restrictions in Sydney, by which time there were 116 locally acquired infections (8). This was too little, too late. Seventy-two days later there were 1,029 new infections: the single worst day on record at the time (8).
This outbreak has highlighted a schism in the Australian health care system between the federal and state levels of government: the NSW government, responsible for health care service delivery, is at the mercy of the federal government to buy enough vaccination supplies. Unable to control the spread of the virus without vaccination, the outbreak is having dire consequences on the NSW health care system. Three Western Sydney hospitals are reportedly at capacity (9), with the nurses’ union advising that multiple facilities are under “enormous pressure” and that emergency departments have “very little capacity” (10). The NSW health department has cancelled all non-urgent elective surgery in Greater Sydney (11).
This is of grave concern. At risk is the capacity of the health care system to provide universal health care coverage to Australian citizens. The health care system is threatening to collapse under the pressure of the COVID-19 pandemic. Although the health care system was initially protected by lockdown measures, the lack of widespread vaccinations and the highly contagious Delta variant have undermined its functioning. The capacity of our health care system to provide care for Australians is the promise of our universal health care system. If we let the COVID-19 virus circulate unchecked through an only partially vaccinated population, we will be unable to maintain this gold standard.
1: Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., Wharton, G. International Health Care System Profiles: Australia. The Commonwealth Fund [Internet]. 2020 June 5 [cited 2021 August 21]. Available from: https://www.commonwealthfund.org/international-health-policy-center/countries/australia
2: The Australian health system. Australian Government Department of Health [Internet]. 2019 August 7 [cited 2021 August 21]. Available from: https://www.health.gov.au/about-us/the-australian-health-system
3: Storen, R., Corrigan, N. COVID-19: a chronology of state and territory government announcements (up until 30 June 2020). Parliament of Australia [Internet]. 2020 October 22 [cited 2021 August 21]. Available from: https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp2021/Chronologies/COVID-19StateTerritoryGovernmentAnnouncements
4: Lupton, D. Timeline of COVID-19 in Australia: the first year. Deborah Lupton [Internet]. 2020 August 13 [cited 2021 August 21]. Available from: https://deborahalupton.medium.com/timeline-of-covid-19-in-australia-1f7df6ca5f23
5: Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian D., Roser, M. Coronavirus Pandemic (COVID-19). OurWorldInData [Internet]. 2020 August 29 [cited 2021 August 29]. Available from: https://ourworldindata.org/coronavirus/country/australia
6: Nicholas, J., Evershed, N. Covid Australia vaccine rollout tracker: total number of people and per cent vaccinated, daily vaccine doses and rate of progress. The Guardian [Internet]. 2021 August 27 [cited 2021 August 27]. Available from: https://www.theguardian.com/australia-news/ng-interactive/2021/aug/27/covid-19-vaccine-rollout-australia-vaccination-rate-progress-how-many-people-vaccinated-percent-tracker-australian-states-number-total-daily-live-data-stats-updates-news-schedule-tracking-chart-percentage-new-cases-today
7: What we know about the ‘fleeting’ spread of the COVID-19 Delta variant in Sydney. ABC News [Internet]. 2021 June 24 [cited 2021 August 27]. Available from: https://www.abc.net.au/news/2021-06-24/covid-delta-kappa-variant-spread-in-fleeting-moment-nsw-vic/100238680
8: Ting, I., Scott, N., Palmer, A. How quickly is COVID spreading in your neighbourhood? ABC News [Internet]. 2021 August 26 [cited 2021 August 27]. Available from: https://www.abc.net.au/news/2021-08-25/how-quickly-is-covid-spreading-in-your-nsw-postcode/100402830
9: Gregory, K. Three Western Sydney hosptials, at capacity, turn away COVID patients overnight. ABC News [Internet]. 2021 August 26 [cited 2021 August 27]. Available from: https://www.abc.net.au/news/2021-08-26/paramedics-stranded-for-hours-outside-nsw-hospitals/100408718
10: Visontay, E., Davis, A. NSW hospitals warning: nurses and staff ‘flat out’ and ‘exhausted’ as Covid numbers soar. The Guardian [Internet]. 2021 August 26 [cited 2021 August 27]. Available: https://www.theguardian.com/australia-news/2021/aug/26/nsw-hospitals-warning-nurses-and-staff-flat-out-and-exhausted-as-covid-numbers-soar
11: Non-urgent elective surgery suspended in Greater Sydney [media release, NSW Health]. 2021 July 30 [cited 2021 August 27]. Available from: https://www.health.nsw.gov.au/news/Pages/20210730_02.aspx