NSW's Chief Health Officer Dr Kerry Chant expressed her dismay this week over the number of elderly Australians yet to come forward for their first Covid-19 vaccine.
She said it was "quite distressing" to see the number of people over the age of 60 who had yet to receive their first jab with the state in the midst of a nine-week lockdown imposed to protect the vulnerable.
Health Minister Brad Hazzard went even harder on Thursday, calling anyone who doesn't come forward for a jab when eligible "extremely selfish" and told them to "wake up".
Statistics shows more than 35 per cent of people over 50 in NSW have yet to come forward for their first jab. That equates to more than one million people.
Premier Gladys Berejiklian continues to stress the state needs to hit 10 million doses administered for a significant opening up. Just 3.8 million have been recorded so far.
So what is causing older Australians not to come forward in a time of need?
Undoubtedly mixed messaging surrounding the AstraZeneca vaccine – the only jab readily available to Australians – has played its role.
Following the emergence of an extremely rare blood clotting side-effect, the Australian Technical Advisory Group on Immunisation (ATAGI) changed its advice for under 60s, saying Pfizer was now the vaccine of preference.
Amid NSW's outbreak that advice has been reverted, however Dame Sarah Gilbert, the vaccinologist who co-developed the AstraZeneca jab, warned it was difficult to get people back on board.
"If you're telling people at some stage you shouldn't have this vaccine and it's probably not the best thing for you and you want to change the message and say 'no, we changed our mind, it's good', I think it's difficult for people to know when to get vaccinated and complicates the situation," she told the ABC.
Why are some older Australians not coming forward?
For those over 60 and who have always been advised to take the AstraZeneca, Professor Jaya Dantas from Curtin University's School of Population Health believes complacency and a lack of enforcement has played a role the low uptake.
"We had very little Covid... and we were not affected by the Delta variant until just recently so there was a certain sense of complacency and we thought we were safe," she told Yahoo News Australia.
"Elderly people have never felt vulnerable (unlike in other countries where infection rates were high)."
She said with the complications of the AstraZeneca highly-publicised, despite rarely found in elderly recipients, older Australians were undoubtedly attracted to an alternative jab in Pfizer and she was aware of people holding out for it. Prof Dantas said a wave of misinformation on vaccines only worsened the problem.
And unlike other countries, Prof Dantas said Australia did not have an effective vaccination plan earlier in the year as the federal government basked in its success at managing to suppress
Prime Minister Scott Morrison famously stressed the vaccine rollout was "not a race".
However a lack of urgency and pressure on Australia's residents to get vaccinated has proven devastating, Prof Dantas said.
What can be done to make older Australians take the vaccine?
Prof Dantas argued governments should have mandated vaccines for the elderly, with restrictions on activities such as going to a restaurant or the cinema in a way countries such as Germany and France have used.
"When you don't mandate it and make it voluntary and leave the choice on people, they feel 'Oh, it's voluntary, I'll wait and watch and see what happens'," she said.
"We should have mandated vaccination for everyone over 70 and anyone over 60 with comorbidities by now."
Prof Dantas said the success of the AstraZeneca vaccine overseas should be highlighted more in Australia. India, for example, has administered more than 400 million doses, including widely across its elderly and Israel, the world's vaccine success story, is lining up the jab for its top up doses.
Dr Chant has this week urged families to ensure they are doing everything they can to assist older family members to get their jabs.
While Mr Morrison announced last month all aged care workers must be vaccinated by mid-September, Prof Dantas said the focus should turn to the residents themselves.
"We need to go to where the elderly are," she said.
In a similar way those whose are not proficient in English, Prof Dantas said the government needs to ensure older Australians, who may not have access to the internet for example, are receiving the correct information through the right avenues.
"The information is there but how people have access to that information is critical."
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