By Mark Kenny

This article was originally published by The Canberra Times.

Scott Morrison’s apparent U-turn to “encourage” under-40s to consult their GP about receiving an AstraZeneca shot, was not a change of rules, nor even of medical advice. It was however a big shift in emphasis, and one calculated to relieve acute political pain.

It sent confusion levels soaring.

And not just for patients. Left out of the loop, the AMA was among many to infer that a panicked government was usurping the Australian Technical Advisory Group on Immunisation and the clinical role of doctors.

Only a few weeks back, ATAGI had advised that Pfizer was the “preferred” vaccine for under 60s, lifting it from the previous recommendation for over 50s. If its first age-based restriction, set on April 8, had not materially dented vaccine confidence, this second one was a hammer-blow.

It carried the implicit suggestion that the locally manufactured AZ vaccine presented a greater risk to under 60s than the super-transmissible Delta strain running rampant in many countries and on the loose here too.

In fact, ATAGI had always said AZ could be administered to under-40s where Pfizer was not available, the perceived danger of COVID-19 outweighed the statistical risk, and informed consent was given.

Another fact. The actual substantive aspect of under-40s change, such as it is, was to give doctors more control over patient options (not less), a Medicare consulting number, and professional indemnity where AZ is prescribed.

Had it been explained properly, this “encouragement” could have offered a faster up-ramp towards full community vaccination – surely a public good. That is now less likely because the confusion and the war of words it provoked has probably exaggerated fears about AZ clotting right across the age spectrum.

But who knows? Change itself has become a barrier to take-up. That, and last year’s failure to procure adequate supply of Pfizer - the truth that dare not speak its name within government.

Health Minister Greg Hunt came close on Tuesday, assuming you could follow him at all.

“Why now, two weeks later, are you advising people to talk to their doctors about going against that [ATAGI] advice … have these decisions been forced by your inability to get adequate supply of the Pfizer vaccine to cover younger Australians, and you have an effective oversupply of AstraZeneca?” asked Seven’s Mark Riley.

“No,” replied Hunt before skiting about the Coalition’s brilliant foresight in ensuring “significant supplies of … sovereign vaccine manufacturing here in Australia”.

“The medical advice has not changed. There's simply a recognition that the access for those who wish to make an informed consent decision can be broadened, consistent with the supply.”

Still confused? Job done. This was essentially a “yes” but obscured in so much verbiage as to sound more like a “no”. And of course, to be unusable for TV news.

In any event, the “recognition” of “access” and “supply”, was known months ago when the initial age distinction was introduced.

So if ATAGI’s medical advice hasn’t changed, what has? Answer, the politics. Amid the return of what might be called COVID reality - failures of hotel quarantine, lock-downs, disruption and fear, Morrison’s Team-Australia has given over to toxic parochialism. National cabinet has become dysfunctional, merely another stage for unedifying commonwealth-state bickering.

Voters can see how leaderless this desultory vaccination program has become. States are openly attacking the federal government. The gloves are off. Protecting public confidence in the vaccination program has gone out the window

Even some federal Liberals concede privately that its delivery has been royally botched. Not to mention its muddled and inadequate sales job.

As public failures go, the roll-out – and the refusal to plan and build dedicated quarantine facilities last year - may be the most egregious and consequential of any federal government programs.

All the more mystifying given the supposed marketing prowess of the man ultimately responsible!

Mark Kenny is a professor at the Australian Studies Institute ANU and host of the Democracy Sausage podcast.