Press Conference - Canberra, ACT

Transcript
03 Aug 2021
Prime Minister
E&OE

PRIME MINISTER: Good afternoon, everyone. I'm pleased to be able to join you here. I'm joined of course by the Treasurer, General Frewen and Professor Kelly. I'm also joined by Professor Jodie McKernon, McVernon, I should say. Thank you, Jodie. It's good to see you. We've been seeing a lot of the Doherty Institute of late, and I'll be asking Professor McVernon to speak to you through the video conference this morning and we are releasing today the Doherty Report that was provided both to the National Cabinet and of course the Federal Cabinet in releasing the national plan and the vaccination targets that I announced on Friday evening from The Lodge.

Can I just make a couple of opening remarks before I throw to Professor McVernon. She'll be followed by the Treasurer who'll be outlining the advice that we have received through the Treasury process that is aligned with the work that has done, been done with the Doherty Institute, and both General Frewen and Professor Kelly are available to deal with any questions that arise, as well as Professor McVernon.

We all know that the world is in a serious battle with the Delta strain of COVID-19. This has been a long war against this virus, and there have been many, many battles, and this is a fierce one when it comes to the Delta strain. As I’ve said on many occasions, Australia is not alone in this battle. This battle is being fought right across the world, as every single country is adapting and changing its responses to ensure that they can get on top of this. Just last night I was talking to the Greek Prime Minister about these very issues and I'm in regular contact with many leaders around the world talking about how they are responding to and dealing with this most recent strain. So, Australia also is joined in this battle.

The tools that have helped us so much over the course of the last 18 months and more have indeed been blunted by the Delta strain. That is a clear learning and that means we have had to adjust our response, and so the reactions of short - hopefully - but strong lockdowns to ensure that the Delta strain does not get away from us, as we're seeing now in south east Queensland, as we saw indeed in Victoria and South Australia, and regrettably in New South Wales where the lockdown continues. This is now our first response when it comes to dealing with the Delta strain. When the circumstances change you must change with them. Under the earlier strains of this virus, then those tools did enable us to be able to prevent lockdowns, it did enable us to manage when cases presented. That has all changed with the Delta strain. The Delta strain is the game changer, and our response has had to change with those changing circumstances.

All throughout this year, though, whether it was Delta or Alpha, we have been working to chart the way back to living with the virus. Of course the virus will never be eliminated. It can take a very, very long time for any infectious disease that is resident in any population around the world - as I’m sure Professor Kelly will tell you, and indeed Professor McVernon - to eliminate viruses around the world. But, you can get to a point where you live with them, and we have been charting out that course since the beginning of this year indeed, when I first tasked Secretary Gaetjens to work with his counterparts in the states and territories. That process led to the first piece of work that was done by the Doherty Institute that was based on the Alpha strain. And, at the end of June, it was very clear that we would have to go back and do it again because of the Delta strain that had now become very clear, and that advice was presented to National Cabinet.

So, last Friday I announced Australia’s plan to live with the virus. I announced the whole country’s plan to get us back to that position where we can ultimately live with this virus, in the same way that we live with other infectious diseases that are present in the community, and we can get on with our lives. That plan is based on common sense precautions that prevail, and it is based on a pathway on vaccination that provides the protection necessary to ensure the many tools we have to suppress the virus, and its impact on lives and livelihoods are held at bay.

The targets that are part of this plan, the vaccination targets of 70 per cent to get to the next phase and 80 per cent to Phase C, are based on the world’s best scientific analysis and economic advice. Australia has been well served over these more than 18 months, as we have charted our own Australian way through this pandemic. An Australian way with Australian results that are different to almost every other country in the world, bar a few. An Australian way that has delivered Australian results that has saved more than 30,000 lives; 30,000 Australians and more would be dead today were it not for the COVID response that Australia has put in place. And, I say all of Australia because everyone has played their part in achieving that outcome. If we had the same incidence of fatality, of serious disease experienced by advanced countries of the world just like Australia's, with serious health systems that can respond to these sorts of pandemics, if we'd had their results, more than 30,000 Australians would be dead today.

But, it's not just that, as the Treasurer will remind you, because Australia is also, off the COVID-19 recession last year, got a million Australians back at work. Now, that is under challenge again because of the restrictions we have regrettably but necessarily had to put in place. But Australia's economic performance and our health performance, saving lives and saving livelihoods, are amongst the world's best, and are the product of, in this country, always finding our Australian way through this pandemic to get the Australian results that have protected lives and livelihoods.

The vaccination program, we have overcome those early challenges, which are very familiar to everyone around the country, and I particularly want to thank General Frewen, who joins me here today, who at the beginning of June took on my task to head up the whole of government effort. I want to thank all those working in the Health Department and around the country - the GPs, the pharmacists, those working in the state hubs - who are getting these vaccines out every single day, to the point now we have some 12.5 million vaccines that have been delivered, or thereabouts. The fact that we now have one in five Australians who have received double dose. We now have two in five Australians who’ve had a first dose. We have around two-thirds of Australians aged over 50 who’ve had a first dose. We have almost 80 per cent of Australians aged over 70 who’ve had a first dose, and, of course, in our aged care facilities, more than 80 per cent of those residents have had double doses.

So, it can be done. It will be done. I have great faith in the Australian people to get this done. Tremendous faith in their determination and their motivation to get this job done. Because I've seen it, each and every day, as we’ve led together, Australia, through this crisis. I’ve seen their courage. I’ve seen their selflessness. I’ve seen their determination. I’ve seen their sacrifice, and that is what has got Australia through to where we are today. I have great faith in the Australian people to get this country vaccinated.

We are making our own Australian way through it, and today I want to share the expert scientific advice, through our experts who are here with us today, that have informed this decision about the 70 and 80 per cent targets to get us to the next phase of the national plan, to get Australia in a position where we are living with the virus. So, I'll hand over to Professor McVernon, to you, Jodie, and then I'll go to the Treasurer to speak to the economic analysis and advice that has come in parallel with that advice and work together, and then happy to take questions. Jodie.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Thank you, Prime Minister. And, there's a presentation that I believe will be on screen concurrently, which I have a copy of here.

PRIME MINISTER: I might just have the volume up a bit in the room if we could, please. Okay, please proceed, Professor.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Fine, thank you very much. Alright, so this slide set summarises the work. Next slide please. And, some top line findings here, really are the purpose of the work, which was to identify vaccine thresholds that could enable the transitions to Phase B and C of the national plan. There's a strong emphasis on maintaining high vaccination rates across phases by offering all adults a vaccine earlier. And, in Phase B and C we are recommending, based on the evidence, that ongoing low level or baseline restrictions and effective test, trace, isolate, quarantine - what I’ll refer to as TTIQ responses - should be used to minimise cases in the community and keep case numbers low. And, as the Prime Minister's mentioned, the experience with Delta has shown that under Phase A, at the present time, lockdowns should be optimally early, stringent and short. Next slide, please.

The next slide details the national plan phases, which the Prime Minister has already announced and described on Friday. I won't go into detail on that today. But, we'll move on to the evidence underpinning those determinations. Next slide, please.

Overall, our modelling makes a series of recommendations and the key recommendations are covered here, and I'll unpack the evidence behind them in the subsequent slides. So, I think the first thing to make very clear is we've heard a lot of discussion of herd immunity thresholds and some magic number where there's a binary cut off and above that life is life as normal and below that we haven't achieved our goal. Vaccination coverage is a continuum. Every Australian who is immunised help to protect themselves, their families and their community, and that will help to reduce transmission and negative health outcomes. And, we look at the outcomes of vaccination are to reduce transmission potential, at this point in the population strategy, as a way of reducing those adverse outcomes. We bring to this the understanding, based on evidence here and internationally, that young adults are peak transmitters of COVID-19. Our elder populations and special risk groups are those at highest burden of severe health impacts, and our program to date has focused on reducing those impacts by directly protecting those groups. What we're proposing now is a shift in strategy at this phase of the program having got to where we have, and the Prime Minister’s outlined those figures in order to really maximise the benefits of this program across all individuals in the population. And, as said in the summary points, vaccination alone is a very big part of the answer but it is not the whole answer. We must maintain ongoing public health and social measures. Next slide, please.

So, we were asked to explore a series of vaccine coverage thresholds between 50 and 80 per cent. And, our simulations basically looked at, should an outbreak become uncontrolled in those conditions, what would the consequences be, and based on that, to provide advice about safe thresholds and strategies before moving to the next phase. At 50 and 60 per cent we anticipate rapidly growing outbreaks that would be very difficult to control and would require stringent social measures. As we reach 70 and 80 per cent, the need for long, stringent measures across whole of states or across extended areas, we believe, will be substantively reduced. And, the graphic on the top right of this slide basically makes that point for what we considered to be the optimal scenario, showing that for different levels of coverage we were able to reduce transmission through vaccination to the extent that the need for prolonged lockdowns to regain control should be substantially diminished. Next slide, please.

This slide's a critical conceptual slide that really brings together all of the key messages of our work in a single graphic. So, the Prime Minister's referred to the fact that this Delta variant has been a game changer internationally, and that's because it has a much higher reproduction number, the number of secondary cases that each infected person is likely to make is essentially double that of the original SARS-CoV-2 strains we were looking at in early 2020. And we, in the absence of having circulating cases most of the time in our population because of effective controls, have developed a metric called ‘transmission potential’ which basically summarises the characteristics of the population at any point in time that would enable the spread of the virus. And, this work’s been conducted by a team around the country, as has all of this work, and the group doing the modelling presented today has strong complementarity and overlap with the group who deliver weekly situational assessment reports to the Australian Health Protection Principal Committee.

And, based on review of what has happened in Australia, based on how they have seen the population behave, how we see mobility patterns in response to different restrictions, and how those levels of restriction have been able to constrain the virus in Australia, we have put together a series of bundles and descriptions of those activities that have been able to be shared with Treasury and provide this advice.

So, starting from a very high [inaudible] or transmission potential, I'm going to talk about now for Delta. We can see that the kind of baseline public health and social measures of hand hygiene and keeping your distance and, where applicable, wearing masks, are actually able to put some constraint on the virus, and when we have a highly effective TTIQ capacity, the public health response, those two together are very useful to already reduce the transmission potential of this virus. And, you can see that that brings that, those pink salmon bars - you may not be able to see well - but come down to another dotted line, which is basically the Wuhan strain transmission potential. So, just those measures get us back to where we started from.

We then overlay vaccine coverage at different levels - and these are the blue bars - and 50, 60, 70, 80 have increasing effectiveness, as you would imagine, to reduce transmission, and that will bring the transmission potential down further. However, you can see that to actually control outbreaks altogether we need to reach the dotted line that crosses one, at which epidemics do not grow. And, you can see that at 50 or 60 per cent coverage, we're still a long way from that line. The green bars in different degrees of shading show the ability of overlaid social restrictions to reduce transmission potential further. And, you can see that at 50 or 60 per cent it would be highly likely that stringent or moderate social restrictions - and our stringent restrictions here are Victoria's phase four lockdown back in wave two in 2020 - would be needed to keep control or regain control of the situation. At 70 per cent we're at a position where the light, low public health and social measures are able to keep us grazing that bar of one, and combined with an effective and well-preserved public health response could help to turn what might otherwise be a bushfire into more of a controlled backburn, and keep case numbers low. And, at 80 per cent coverage, we would be more confident that some greater social freedoms might be allowed with that level of immunisation. Next slide, please.

Just to unpack why this is important, and these slides are not projecting well on the screen I can see, so I'm going to have to talk through the figures. But, as we move to higher levels of coverage, the rates of symptomatic and severe infections are greatly reduced in situations where vaccination is holding the line and we don't have those overlaid social measures. So, this is still a suboptimal strategy but it's showing you why those overlaid measures are important. As we move, if - on the top left graphic - up from 50 per cent at the bottom to 80 per cent coverage, we can see that the number of symptomatic infections reduces, as do the severe infections arising from it. The graphic that I suspect you can’t see on the bottom right breaks those severe infections down into deaths, ICU admissions and ward admissions. And, obviously they’re all decreased across the board.

Now, this is an artificial scenario that we’ve modelled. We're assuming, we’re, you know, some models are wrong or some models are useful. But, we are making a strategic case here by looking at the whole population and saying, if we can achieve this coverage evenly, this is what we can do. Obviously, in implementation it will be very important to ensure that jurisdictions, small areas, key sub-populations achieve these high coverage thresholds, because while unvaccinated groups remain there is still potential for transmission and outbreaks and severe disease outcomes in groups that are not reached by immunisation. Next slide, please.

The next slide speaks …

PRIME MINISTER: Just, just, we might just hold that there because that slide people weren't able to see. But, just to reinforce a point that you’ve made to us on several occasions, that when you get it down to 80 per cent, the sort of death, hospitalisation and infection rates is what you expect to see with something like the flu.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Thanks, Prime Minister. Alright, so we're now on slide 7 of the pack. Thank you. This slide speaks to the strategic shift. So, we started with our population immunisation coverage, working with the team in Health who have been supporting Australia's vaccine rollout. So, with up-to-date information on supply, distribution, capacity, to devise a series of scenarios about how we might use our vaccine from here. So, we started at a census date of 12 July, having already achieved high coverage in many of the at risk groups, and explored strategies for next allocations. And, there are two strategies that are compared on this slide. If you look at the figure on the bottom left, we refer to two different allocation strategies - one called oldest first which basically means we keep working our way down the age groups in the population and try to maximise uptake, before moving to the next. Another hypothetical strategy we called all adults. You know, as a comparison we said, what happens if we just offer vaccine to everybody right now. How will that serve the program? And, you can see that at each achieved threshold vaccination coverage, the all adults blue line is well below the oldest first brown line, showing that there's obviously, the way you allocate that strategy and who is covered in the population is important.

And, I'll try to cover off on the figure on the right briefly. This is called an age-based transmission matrix, or a who acquires infection from who matrix. This is a standard tool in infectious disease modelling and it acknowledges the fact that people who are in the population, of different ages, mix differently with others, and may be more or less susceptible and infectious than others. So, these charts start with social surveys that ask people who they come into contact with. Not surprisingly we find that most people hang out with people about their age. So, if we look at where the matrix squares are darkest, there's always a strong diagonal reflecting that. We also see these, sort of, fainter wings off the side of that. This reflects mixing in households between adults and children, and it’s in households that the age generations combine. Now, if we were drawing this matrix for the influenza, and here the matrix is additionally coloured by susceptibility and infectiousness, we would see the darkest squares in this matrix in the age categories of five to 14. Children haven’t been exposed to flu as much as adults, they’re more susceptible, they're peak transmitters, they bring flu home to their parents and their parents then take it to their friends. But, for this virus, it’s different. And, we know this from looking all around the world over the past 18 months. Yes, children can get COVID and we are concerned about them becoming infected and infectious, but they're nowhere near as good at it as their parents are. And, so, in this virus case it's really the 20 to 39 years category who are the peak spreaders, and they will bring COVID home to their children, they will take it home to their own parents, and this is the group now where we're proposing the reorientation of the strategy. Next slide, please.

We make that point by taking effects on transmission through to the next logical consequence, and this work involved a series of models of models. I said before, there are a lot of buckets along the far chain here, as models of both infection transmission, epidemic dynamics, and then the consequences of those infections all feed into each other. And, so, the tables on the next three slides will refer to the clinical outcomes of these infections and breakdown where the infections are occurring, what age groups and by vaccine status, you know, who is getting infected. And, it's important to remember the vaccines we have are extremely good, but no vaccines are perfect. And, as we increase population vaccine coverage we expect to see more cases in people who are vaccinated, just because there are more of them.

This is a very busy chart, so I'm going to take you through the key messages one by one. The main story of this chart is the comparison of that oldest first and old, all adult strategy. So, are we looking for direct protection or are we really maximising the impacts of a vaccine that we know now reduces transmission by targeting transmitters. So, we're going to start with the 60 plus column, because this is an age group obviously of concern in terms of severe outcomes. And, within, under the 60 years column we have outcomes for vaccinated and unvaccinated individuals. And, under all our strategies, under the allocation modelling that was undertaken, we get to something like 85 to 90 per cent coverage in that critical age group. So, direct protection remains critical.

I'm then going to take you through, first the darker shaded bars for the oldest first strategy. So, we can see, if we look at vaccinated versus unvaccinated, we have 2.5 times as many symptomatic infections in the vaccinated group. There are nine times as many of them. If we then look at the consequences of those symptomatic infections, vaccines protect individuals against progression to severe outcomes. By the time we step through ward admissions, ICU admissions and deaths, we end up having fewer deaths off 2.5 times as many infections at the beginning. So, this shows that the additional impacts of direct protection are critical. The oldest first strategy still works well for vaccinated people. If we then compare those darker shaded bars with the lighter shade of bars, so we have essentially the same vaccine coverage in this 60 plus age group, by pursuing an all adults transmission reducing strategy we halve all of these outcomes all the way down. So, this is showing why at this point a strategic shift to targeting transmission and stopping these people getting exposed in the first place can substantially improve outcomes.

And, I'll just quickly reflect on the fact if you look at the less than 16 years group, and in none of our modelling have we, or none of the models presented here, consider immunisation of school children. But, by vaccinating parents you protect children, and if you look again at the oldest first and the all adult strategies you can see that adverse health outcomes in children are dramatically reduced by this strategy as well. Next slide, please.

So, the next two slides I'm not going to speak to in as much detail but I'll frame the key messages of them. This next slide, the addendum to the modelling, which is the second part of the technical report, basically took that key message that immunising younger people, reducing transmission is critical to maximising the gains of a whole population program, and worked again with the team in Health to devise a strategy that was feasible and implementable. And, this is a strategy that basically follows where we are right now but brings forward immunisation of the 30 to 39 years group to the beginning of September and 16 to 29 to early in October. And, if we roll our program out that way, the key message of these slides, and I'll leave you to look at the detail later, but these darker lighter rows now compare our hypothetical strategy with the feasible strategy, that we call transmission reducing. And, we see that across these various columns and down the rows we achieve slightly better outcomes with that feasible strategy. So, we were very pleased that something that was practical certainly captured the benefits of that earlier hypothetical proposal.

And, just on the next slide, the other thing to point out here, so this is coming back to this idea of synergies between interventions. So, we’ve said in the earlier slides all of these outcomes are if all you have is vaccination and some degree of contact tracing, but it's getting stressed because your case numbers are getting high. If we preserve the system by maintaining some low level restrictions and supporting that public health response, if you look at the dark and light shaded bars all the way down this particular chart you can see that we can achieve substantive reductions if we can maintain that capacity and maintain those community behaviours by 100 fold or more. So, this is very strongly the case that supports a combined strategic approach for the shift to Phase B. Next slide, please.

This final slide just summarises, again I'm sorry that some of the shading is out there, so I will read out some numbers for you. We are still understanding the Delta strain, we are still gathering evidence around the world about vaccine effectiveness against this strain, and in a whole range of population settings that are quite different from ours, where different proportions of the population are vaccinated and different measures have been in place and case loads from the beginning are very different. But, basically, what we are delighted to see and what really supports the use of both of the vaccines that we have in Australia is that both the Pfizer and AstraZeneca doses are highly effective at reducing severe disease outcomes following two doses. And, I'll read the numbers out for you because they're shaded. But, basically, for Pfizer, reduction in hospitalisation is 87 per cent, ICU admission 87 per cent, mortality 92 per cent. And, for AstraZeneca, the corresponding numbers are 86, 86 and 90 per cent. So, we have two very highly effective vaccines and this work really encourages their best strategic use. Thank you very much.

PRIME MINISTER: Well, thank you very much, Professor McVernon. And I'm now going to ask the Treasurer to take you through the economic advice.

THE HON. JOSH FRYDENBERG MP, TREASURER: Well, thank you, Prime Minister and Treasury work very closely with the Doherty Institute and Treasury will be putting out a paper later today which has the assumptions upon which their numbers have been reached. The first thing to say is that Treasury has undertaken analysis of the various COVID scenarios modelled by Doherty. And what they have done in this analysis is calculated the impact on economic activity, the direct economic cost at various vaccination rates, 50, 60, 70, 80 per cent. Importantly, the Treasury analysis is on the direct economic cost. It doesn't calculate the fiscal cost, namely the income or business support that as we know, goes out in the case of lockdowns and and other restrictions being put in place. It doesn't calculate the confidence effects that the lockdowns or other restrictions may have, and it doesn't calculate the labour market scarring impact that you may see from people being out of work. It focused firmly on the direct economic cost, which is effectively the impact. On GDP, three simple conclusions or findings from this work. First, that lockdowns and their costs are very significant. So should Australia see nationwide stage four restrictions, as we saw in Victoria in August of last year, the cost to the national economy is $3.2 billion a week. Should we see stage three restrictions across the country, the nature of which we saw last May, the cost to the economy is $2.35 billion per week.

These numbers underline the imperative of Australians getting vaccinated. It is the way out of this crisis and it is the way to avoid in the future longer, more severe lockdowns. The second key finding or outcome from the economic analysis is that the economic cost comes down significantly, if governments work quickly to get on top of the virus. This is the Prime Minister's point, early interventions, short, sharp lockdowns are the most cost effective way to handle the virus. Particularly, at the current time. And so what Treasury have found, is that at 50 and 60 percent vaccination rates, it's five times more costly, should governments not move early to get on top of the virus. And that's the short, sharp lockdowns that we're now seeing in Queensland, that we've seen in Victoria and that was seen in South Australia. The third key point out of the analysis, is that the economic cost to the country of managing COVID comes down as vaccination rates go up. So at 50 percent vaccination rates, if governments are getting on top of those early cases, it's costing the economy $570 million a week. At 60 per cent vaccination rates, if governments are getting on top of the cases early, it's costing $430 million a week. At a 70 per cent vaccination rate, it's costing the economy $200 million a week. And at 80 per cent vaccination rates, it's costing the economy $140 million a week. And that's baseline type restrictions, light or moderate restrictions. So there's one very clear message out of the economic modelling, which very much complements the work of the Doherty Institute, is that until we get to 70 per cent and above vaccination rates, the economic imperative is that governments need to move fast to get on top of those cases. If they don't, we see lengthier and more severe lockdowns, which have a much more significant economic cost. Thank you, Prime Minister.

PRIME MINISTER: Thank you, Josh. Happy to take questions.

JOURNALIST: Prime Minister, if I am reading this correctly.

PRIME MINISTER: Could you let me know if you would like to ask Professor McVernon.

JOURNALIST: My question might be relevant but I’ll put it to you two chaps at the start. If I'm reading this correctly, if we get to 70 percent vaccination, the next step, then we would still lose about 2,000 lives in the first six months and 80 percent, which is, which is much freer, it's 1,300 lives in the first six months, as you say, that's the that's equivalent of flu. Given those numbers, does it alarm you that many months into the availability of vaccine for over 70s, we still only have 79 percent who've had one jab, which means that one in five of the most vulnerable Australians haven't got a jab yet?

PRIME MINISTER: I'll make a couple of comments and I might then throw to Professor McVernon because that would put her work in context. No, it doesn't really mean what you've just said. What has been modelled here is a scenario at those levels of vaccination where there is an uncontrolled outbreak that runs for 180 days. So it's not like an annual fatality figure of vaccinations. That is not what it is depicting. And I have no doubt that if such a scenario were to eventuate, then there are additional measures that would be taken to avert those types of outcomes. In the same way, if we had a very aggressive flu strain that was moving in a similar direction, that would have similar results, then obviously governments would take steps. But the likelihood of that occurring under an 80 per cent vaccination rate or indeed the other figures you have there at 70 per cent, is obviously very different. So I think it's a very important question, Andrew, to get that in context, that at those rates you have a very high level of protection similar to what you have in dealing with infectious diseases like the flu. That's why I talk about a path to living with the virus, because that's what we're doing with other infectious diseases.

Now, I welcome the fact that we've got, and this week within the next day or so, we will passed 80 per cent first doses for those over the age of 70. You already know that we've got double doses in aged care facilities of over 80 per cent. And as we've seen in the most recent Sydney outbreak, we are not seeing in Sydney what we so terribly saw last year when vaccines weren't available. And that heartbreaking situation that we saw in Victoria is while there have been terrible loss of life in Sydney, we are not seeing a repeat of what occurred in Victoria last year, and that is because of the significant rates of vaccinations that have been achieved, particularly in aged care facilities. And when you're at 80 per cent or thereabouts on first dose, then the second dose follows. That's what we're seeing from overseas as well. And we encourage people to get that second dose and particularly in Sydney. That's why the ATAGI advice and guidance has been about the four to 12 week and drawing forward to four, to ensure that second dose gets in earlier. But I’ll allow Professor McVernon to comment further.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Thank you, Prime Minister. And really here, I think it's important to reflect that what we are offering here is a hypothetical scenario that's a thought experiment, not a prediction. And just to walk you through those numbers a little bit more closely. So, yes, you've captured the figure where, you know, 70 per cent coverage, we see 2,000 deaths within 180 days at 80 percent. We see 1,300 within 180 days. This is an artificial population where there is a single outbreak. This is a scenario where we roll vaccination out and we stop at 80 percent. So that's it. And then we let things unfold from there. Clearly, we're not going to stop at 80 percent. We would be still looking to target those groups who have missed out. In every country, we'll see that if we only get to a certain level, that we will continue to see outbreaks of disease in the unvaccinated population. And so basically, if we stop at 80 percent and we just let it sit and we don't do anything else and we don't have optimal TTIQ and we don't have additional public health measures, those people will eventually get infected. And because it's been slowed down in the 80 percent scenario, some of those deaths are yet to occur. So it actually doesn't do better in the end. It just takes longer for them to add up. But in discussion with Treasury, we both agreed on a six month reporting timeframe. Then going back to slide 10.

PRIME MINISTER: So I'm going to revert to that old practise and I'm just going to work around the room. So we're already over here. Phil? Yep, David.

JOURNALIST: Thanks, PM. I've got a question about modelling and about policy, so for you and Professor McVernon. There's a lot of debate, obviously, about not just getting to 70 or 80 per cent, but how you get there. Did the modelling look at things that have been done overseas to encourage people to get vaccinated, like the French model of the digital pass or the health pass where you've got that incentive and then behaviour changes if you do not get vaccinated. Was that ever part of the modelling and the PM, given the Treasury findings here and also Professor McVernon's modelling, what's your response to the need to get people vaccinated? Do you like what France is doing with that health pass or is that a little bit too onerous compared to what you might contemplate in Australia?

PRIME MINISTER: I’ll go to Professor McVernon. Then I'm going to ask General Frewen, I think, to comment on the issue of incentives and the work that Operation COVID Shield has been doing on that matter. Professor.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Thanks, Prime Minister. So in terms of the modelling, no, we didn't specifically model behavioural incentives. The model scenarios came from health based on observations of how the rollout has been progressing and the ability to deliver. So the work about incentives is part of the implementation of this thinking. Thank you.

PRIME MINISTER: General Frewen.

LIEUTENANT GENERAL JJ FREWEN, COORDINATOR GENERAL OF OPERATION COVID SHIELD: Thanks, Prime Minister. Look, at the moment, I'm really encouraged by the willingness of Australians to come forward to get vaccinated. We've got really strong signs that the vast majority of Australians intend to come forward to get vaccinated because it's the right thing to do. And that really is the best incentive right now is to do it for themselves or their friends, for their families, for their communities and for the country. So right now, we don't think, you know, incentives are necessary. And as I said, it's really pleasing to see just how many Australians are willing to get vaccinated.

PRIME MINISTER: And in relation to the question you put to me. Australia has one of the highest vaccination rates, when you look at things like child immunisation and things like that, in the world. Australia is very used to vaccination, and that's why we have those high immunisation rates that other countries, frankly, desire. And so we're used to it and understanding it. That's why things like the TGA, that’s why ATAGI, these important safeguards that we have in our system are so important. And that's why we have always ensured that those bodies, particularly in the first instance, the TGA, the Therapeutic Goods Administration, they didn't cut corners, that they weren't rushed, that they were able to do the work properly. In so many other countries because of the high rate of death and the chaos and crisis that was present in those countries, they had to do emergency approvals. And what we did is we ensured that those agencies were able to do their work and to do it properly. And why? So I can stand here with you now with General Frewen and the Chief Medical Officer and say to you very clearly that the vaccines that we're asking Australians to take, we didn't cut any corners. We didn't rush them through approvals. We exercise the medical caution that Australians expect of us to ensure that when they go to get their treatments in their injections, that they can have the confidence that that process has been done properly.

Now, I had the opportunity to speak with President Macron, as I've had with many others who have been dealing with this issue. I spoke with President Moon about the measures that they've used there and, and Prime Minister Suga about what's happening in Tokyo, in Japan more broadly, and what our plan does. What our national plan does is recognise that Australians who are vaccinated have a lower risk of getting the virus, transmitting the virus, getting dreadfully sick from the virus and being hospitalised and dying from the virus. And so in that circumstance, those Australians pose a lower public health risk than those Australians who are not vaccinated. And that is the basis upon which our plan in Phase B enables exemptions to be provided to vaccinated persons because they are a lower public health risk. And as General Frewen has often remarked to me, that opportunity that comes from being exempt is a positive motivating factor. OK Phil.

JOURNALIST: To General Frewen and Professor McVernon, if I could. Professor, did the modelling look on the flip side of the impacts on people's lives and so forth of lockdowns and non-COVID related consequences of lockdowns. And General, you said you were confident we don't need incentives, is that to get to 80 per cent or above? And do you have a view on the merits or otherwise of the proposal the Labor Party's put forward today on cash payments?

PRIME MINISTER: Professor McVernon.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: I'll take the first. Thank you. No, this modelling is basically confined as an infectious disease dynamic model and the health impacts reported are all COVID related. Thanks.

LIEUTENANT GENERAL JJ FREWEN, COORDINATOR GENERAL OF OPERATION COVID SHIELD: We won’t need incentives on the table, but right now, what resonates most strongly with people in Australia seems to be, you know, the incentive of being able to travel internationally again to, you know, not have to quarantine to, to avoid lockdown. So that's what seems to be most strongly motivating people right now to get to those high levels of vaccination that we need to get to as these research shows.

PRIME MINISTER: I'm conscious of the hour, but Question Time is not till 2. So am I going to keep working through, so don't worry about not getting a question up.

JOURNALIST: Question for the Professor and perhaps for the Prime Minister, that modelling you've described it talking about the patterns of infection over the past 18 months. The pattern over the next 18 months will be different. You've talked about youth being peak transmitters. There's a cute line about, you know, if parents are vaccinated, their children will be protected. But those children also go to school. They go on buses, they go on trains. So will there be another set of modelling that looks at risks and patterns to protect those under 16? Or are they simply being left to be hospitalised and not vaccinated?

PRIME MINISTER: I'll go to Professor McVernon. But on the last part of your question, of course. This work never ends and it continues to progress. And we will continue to ask all of those questions. Why? Because the virus doesn't stop and it keeps evolving. And we need to keep doing the work involving the Doherty Institute and many others. And as I'm sure the Professor has always acknowledged, there's a very big team of people who draw all this together. And then there's the work of the AHPPC led by the Chief Medical Officer. So, yes, the work will never stop because the virus won't. Professor.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Thank you. Yes, so we have been measuring COVID in Australia over the past 18 months, and that's included emergence of Delta here. So our understanding of its transmission characteristics are based on what we've observed, our understanding of the impact of interventions and the proportionate reduction in transmission potential is again based on what we've observed. So we are always encompassing that new information. And we actually report weekly through the common operating picture, the transmission potential now of Alpha and Delta variants as part of our routine procedure.

On the question of children, clearly in countries where there have been high levels of immunisation uptake and where schools have been one of the more free social venues, we have seen many reports of increasing representation of children in the disease cases, and we would expect that within that context. And we are carefully attending to all of the emerging evidence about children and their role. And I think I flagged that, you know, 80 per cent was the coverage threshold we were aiming for. But there is also room to go further. And we did specifically do a subcomponent of the modelling and the full technical report that looked at the impact of immunising in a targeted way, 12 to 15 year olds at this point in time, and showed that across the whole population, the reduction in transmission achievable would be very modest. Nothing if, if either zero or minus point one on the transmission potential, if those numbers mean anything, meaning that at this point in time that's not an efficient strategy for reducing transmission. We recognise, I am a parent, I was a paediatrician before I became a public health physician, I'm a clinician modeller, that children are very important. And so a strategy that protects them as well as elders in the population and the middle and the working age people we believe to be the best strategy at this time. And we will have more evidence over the next six months about the best approaches in children. And clearly preserving their education is critical. We believe this whole population strategy achieves the best outcomes for all at this time.

JOURNALIST: Can I ask, the modelling assumes that vaccination coverage is uniform. But you do mention the potential problem of outbreaks spreading quickly through subgroups that aren't vaccinated. Did you look at how that could, how that could happen and how vulnerable those sub-groups are and what the consequences of that are? And also, could states achieve better results in terms of hospitalisations and deaths by continuing with state border closures?

PRIME MINISTER: Professor.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Quickly knock out the fact that we're not thinking about border closures here. That's not part of our remit. In terms of those sub pockets, yes, they are very important. And we're still discussing exactly the next phase of this work. But the, the proposal is to look in more detail at some of those groups who would be particularly targeted and at some of the additional measures. And, you know, at this point in time when COVID cases emerge, you know, we've seen challenges in south western Sydney. We know we've had challenges in Victoria. In different population groups and in different populations settings, the public health response is tailored to the situation of the time. And we're saying that, you know, the need for targeted vaccine coverage and enhanced vaccine coverage in some groups combined with those early and effective public health responses will continue to be critical for managing COVID.

PRIME MINISTER: No lockdowns, there's no need for borders. So it follows a similar path on the vaccination rates.

JOURNALIST: A follow up to that question, actually. You know, we've seen data today that shows the vaccination rate across Australia is quite different, depending on whether you are in a wealthy inner city area or you're in poorer parts of Sydney and Melbourne or you're in remote parts of the country. To General Frewen, I mean, how important is it to make sure we have even vaccination coverage and maybe to Professor McVernon, you know, does that mean that we've got the potential for pockets of big outbreaks and deaths and hospitalisations in these areas where we don't have that vaccine coverage?

LIEUTENANT GENERAL JJ FREWEN, COORDINATOR GENERAL OF OPERATION COVID SHIELD: You know, it's really important that we vaccinate the nation as consistently and as evenly as we can. The data that we've released yesterday gives us good insight into how progress is going. And we'll be watching very carefully from here on in to see where some areas are moving ahead and where other areas are falling behind. And then we'll be adapting the plan and offering additional assistance to those areas that do need to be to be brought along a bit more quickly.

PRIME MINISTER: Professor anything to add?

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: I'll just say it highlights the really important role of community engagement in the public health response, and that's including supporting vaccination and, you know, just reinforcing that to try to improve coverage in those hard to reach populations.

JOURNALIST: In this report, it says that it's not possible to constrain an outbreak with a moderate lockdown or lighter restrictions even when vaccination rates are between about 50 and 70 per cent. So you need that strict lockdown right through the 50 and 60 per cent to constrain an outbreak like the one we're seeing in Sydney. Does that mean when Gladys Berejiklian said today that if New South Wales gets to 50 percent vaccination rate, there might be a brighter future after the next couple of weeks, that that's false hope because this report says they won't be able to constrain the outbreak without a strict lockdown until upwards of 60 or 70 percent vaccination?

PRIME MINISTER: Well, I might ask Professor Kelly to make a comment on this, but I make this point. This work is being done based on COVID present, not present across the whole country. It is not a piece of work that talks about breaking lockdowns. It's a piece of work that says in order to prevent long lockdowns, in order to prevent the economic costs, which is the same, the same advice that we've received from Treasury, you need to do the short, sharp ones. And so that is the necessary policy response that has been put in place. In terms of breaking out of a lockdown, well, that's a different set of factors. There's no doubt that as vaccination rates rise, that tempers the ability of the virus to spread. But for a lockdown to work, the lockdown has to work. I've been saying that quite consistently. The vaccine certainly assists, but stopping the mobility because the virus doesn't move on its own. And so getting control of that, that spread, which is exactly what the Premier is seeking to achieve, is the real goal here. But, Professor Kelly.

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: Thank you, PM. The point I was going to make firstly is that the modelling is based on a national picture. And so, as Professor McVernon has said, the next iteration of modelling will look at in more detail at localised effects of various scenarios. So I think what we're seeing in Sydney right now is different to what's been modelled. That's the first point. The second point, I'd also like to say my heart goes out to everyone in Sydney, my father is there in isolation, and my sister is home schooling her children and so forth. So all of these things are very tough and difficult, but we need to hold the path. The modelling very clearly shows once we get to a certain point in the vaccination strategy, which is in the next few months, we'll be able to look at that point and say that we can, can see a soft landing from this in a way that no other country has seen to date. And that's the great hope that we see in this modelling. It will be tough to get there. And after we get there, the vaccination will also continue to rise. But we'll need to have those other public health and other measures in place as well.

PRIME MINISTER: I’m going to start with Michelle, and then I'll come across this side of the room.

JOURNALIST: To the Professor first in view of the what you were saying about the differences in transmission groups, which are most likely to transmit the disease in the community, do you think that the original rollout map was appropriate and what changes might be needed in light of your modelling to that? And to the Prime Minister, I think that the Health Minister said yesterday that the ATAGI advice on children 12 to 15, the general population of children, would be some weeks away. I think he might have said about a month away. Is there any way that that can come forward more quickly?

PRIME MINISTER: Well, I might refer that one to the Chief Medical Officer, because he's closer to that ATAGI process.

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: So firstly, on the ATAGI process, they've announced yesterday that Minister Hunt mentioned. In terms of the of the children strategy, they've gone down the path, which is actually very similar to the adult strategy at the beginning, as you will recall, starting with those priority groups and looking at people that are more likely to have severe outcomes from the infection, recognising that in children that is extremely rare. So they've gone down that targeted approach. As more evidence accrues from countries that have gone down a different pathway, for example, in the US, where they are doing a blanket approach to all children in the coming months, they will, of course, continue to look at that information and make assessments as is necessary.

PRIME MINISTER: Up the back and then we'll move forward.

JOURNALIST: My first question to the Professor?

PRIME MINISTER: Sorry, Michelle.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Yes. Short answer, was the strategy right to start with? Yes. We, with all other populations and considering the ethics and all other things started by directly protecting those at most risk of severe outcomes. And the gradient of severity varies so substantially by age and the risks of death vary by age. All developed populations have focussed on risk reduction first. Where we are now, off the base of what has been achieved with the program, looking at the best strategic use in moving forward, a recommendation is to pursue a strategy that draws on the direct protection that's already been achieved, but amplifies it by focussing now on transmission. So if that baseline hadn't been there, we would have had to have an intermediate strategy, I suspect, to be able to take account of that group. Does that answer your question?

JOURNALIST: Prime Minister, one for yourself and maybe the Professor as well – as a follow up to Andrew's question earlier. As you mentioned, the projections are based on different levels of potential outbreak. But is there a baseline level of cases, hospitalisations, deaths that we will see into phase B and phase C? I mean, Australians are used to COVID zero, essentially, at this point. But what numbers should we be preparing for once we do move into those later phases? Are we talking dozens, are we talking hundreds?

PRIME MINISTER: Let me make one very quick point and then I'll pass over to both the CMO and Professor McVernon. Phase B and Phase C of the plan envisage a change in what we're managing. So you're moving from managing and suppressing cases, because you know in a population where we are now, that cases turn to hospitalisations, turn to serious illness and in some cases death. The plan shifts in Phase B and further in Phase C, where our focus is on managing hospitalisation, serious illness, and, of course, avoiding those fatalities. So those outbreak scenarios, which Doherty have modelled, indicate that when you get to that 80 per cent –  and I stress that 80 per cent with sensible living with COVID precautions – then you are dealing with a scenario that's not unlike living with an infectious disease like the flu. So there will always be infectious diseases resulting in hospitalisation and indeed in death. That is something that happens, sadly, each and every day. But that's the world in which you live. And I think Australians understand that. But it does enable us, when we get to Phase B and especially in Phase C, to move away from that being the focus. And what we are then looking at very carefully are those other matters. But Paul and Jody?

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: So I think it's a really key point that we've made here on several occasions. We have, at the moment, a national strategy which has been devised through the AHPPC and endorsed by National Cabinet of suppression with no community transmission. That is our strategy at the moment. And there are two reasons why we have that. The first one is to minimise that transmission in the community so that we don't have those severe illness outcomes and therefore minimise those hospitalisations, ICU and deaths. We've seen what's happening right now in Sydney in relation to that increasing number of ICU admissions, the increasing number of hospitalisations and very tragically, those increasing numbers, though small, of deaths, mostly in unvaccinated people. We need to move with that four phase plan to a different phase. We do need to accept that there will be cases. We need to accept that there will be hospitalisations, there will be ICU admissions and there will be deaths. So we do need to go back to that original suppression strategy that we had at the beginning of the pandemic last year, which was based on coping with that, as well as minimising those numbers. And so we need to revisit those plans of capacity in intensive care, in hospital capacity, as well as continuing to have – and this is very clear from the modelling – the very best testing, tracing, isolation and quarantine elements of our public health response.

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: Thanks, Paul. And just to reiterate, Slide 10 is the most important answer to your question here. So all of these other figures about thousands of deaths and so on are configured on allowing cases to escalate, losing some measure of public health response capacity and having only baseline restrictions. So slide 10 indicates if we can keep some social measures on, if we can maintain that public health capacity and if we can allow the synergy of those interventions to work together, then we can potentially reduce adverse outcomes 100 fold. And that's the really critical message, is that as before, there is no one thing to do. If all of those things are combined and if the population can come on board and we can keep those behaviours – the population has been amazing in really cooperating with the COVID restrictions and they've seen the benefits of that. This is best for health. And as Treasury's told us, it's also best for the economy to keep case numbers low through these combined strategies.

JOURNALIST: It took 10 years from 2007 to 2017 to get from the 70 percent vaccination rate to the 80 percent vaccination rate with the HPV vaccine. What makes you think, when other countries like the US and the UK who have had longer vaccination rates or longer vaccination programs than our own, what makes you think Australia is any different? And will you consider, or if you won't, why won't you consider giving Australians cash incentives for vaccinations?

PRIME MINISTER: Well, first of all, Australians understand the challenge. Australians want to get on this path so we can live with this virus and they can return to a life they knew, as far as possible. This is a very different public health challenge to what we've seen before, simply because of its scale. It's a one-in-100-year pandemic. It is a pandemic that reaches the entire population and has imposed very significant restrictions right across the country with very severe economic consequences, both lives and livelihoods lost. So I think Australians are in no doubt about the seriousness of this public health crisis and how every single Australian has a role to play in ensuring that we can get this plan implemented and we can get Australia vaccinated. And General Frewen and his team have been working tirelessly to ensure that both the supplies, the points of presence, the GPs, the pharmacists, all of these things are working to ensure that we can meet those targets and get Australia to where we want to be.

Now, we have always been led and informed by the evidence and the clear expert health and economic advice – and I stress health and economic advice – all through this crisis. Over the last more than 18 months, the Treasurer and I, the health minister, the Cabinet, have sought to understand the challenges that are both health and economic. That's why I've always said saving lives, saving livelihoods. And I stress again that Australia has achieved on this front like few other countries in the world today. And we will be able to get Australia to a point that we will be able to add vaccinated to that list. Now, I have great faith in Australians to do that. As General Fruen has indicated, his team have looked at the incentives and his conclusion he's already outlined to you.

I think the proposal that has been put forward by the Labor Party and Mr Albanese is a vote of no confidence in Australians. It says to them that their health concerns that they might have about a vaccine can be paid off. And I don't think that's the view of Australians. I've seen Australians respond with courage, determination and kindness over the past 18 months to get through. Doing it for the cash, I don't think is what would motivate an Australian to do this. I think doing it for themselves, their family, their communities and for their country is what motivates them to do this. And so, sure, you know, it's a bubble without a thought. Sure, it demonstrates, I think, a lack of considering the real evidence here and informing themselves in terms of a path they're going on and understanding the unique Australian characteristics. Carbon copying a plan from another place doesn't necessarily work in Australia, particularly in a country that has a very strong record on vaccination and not appreciating that. I mean, just think about it. We've got almost 80 per cent of over 70 year olds. Didn't have to pay them. They understood its importance. They've gone and done it. About two thirds of those over 50 have done the same. They were the populations that have had the greatest opportunity to go and do this. Do we really think that Australians of younger ages are less committed to their own health, the health of their families, the health of their communities than those who are older? Of course not.

Our plan is backing in Australians, it always has. Backing them in with the economic support to get through the crisis, backing them in on their values and their commitment. This is a serious public health crisis. It's not a game show. And it's very important that we continue to respect how Australians are engaging with this process. So if they do have hesitancy about vaccines, I'm not going to pay them off. I'm going to pay a GP to sit down with them and talk them through their concerns, which is what I have already done. Because that's how you can alleviate their concerns. I'm going to say to them that if you're vaccinated, then you present a lower public health risk to the rest of the population. And therefore, it's only common sense that you could be exempted from certain other restrictions that might have to be placed on others for their own protection, because they're unvaccinated. That's the scientific approach. That's the approach that we are taking. That's the clear evidence based plan that we're taking. Not a thought bubble, minus the thought.

JOURNALIST: Prime Minister, National Cabinet has agreed, in principle, to easing restrictions and the severity of lockdowns once we get to 70 and 80 per cent. But how can you be so certain that they will stick to that plan once we get to that point, given we have seen so many go it alone in the past? And will you be disappointed if they do go their own way at that point?

PRIME MINISTER: Well, my disappointment won't be the issue. The disappointment of the Australian public will be the issue. See, we're living at a time now where the responses that are now being put in place –  quick and hopefully short lockdowns – that's how you stay ahead of Delta until you reach these marks. At an earlier time then it was different. And states like New South Wales had been in a position where they'd been able to manage it with their outstanding contact tracing and testing systems. But what you've seen from the Doherty's work is that when you hit 70 per cent and 80 per cent, and when you see from Treasury's work that those types of widespread actions can't be justified on the medical evidence and can't be justified on the economic evidence, then I think that is something that will inform, I think, the public's response. Now, at our meeting last Friday, there was strong commitment from all states and territories to this. And I note the comments of Mark McGowan. I believe he's been taken entirely out of context. And to be fair to Mark, because we speak a lot, at any stage, let's say we have a remote indigenous community. The question came from this side of the room where there may be a population that is highly unvaccinated and therefore presents a real risk. Well, of course, if there's a problem, they'll have to take action.

One thing that you don't do in a pandemic like this is pretend that you can know everything and that you take tools off the table. But the need for those tools, as the modelling shows and the evidence shows, is highly unlikely. Highly unlikely. And certainly once you get to 70 and 80 per cent, I think that evidence is very clear. Now, what you've heard today, what the country has heard today from the best expert evidence that you can get anywhere in the world, is exactly what the Premiers heard last Friday and Chief Ministers and that my Cabinet has heard. And I think that information, that expert evidence, backs in our national plan to living with this virus. And, of course, all Australians would expect Premiers, Chief Ministers and a Prime Minister to abide by that plan. I think it's a question of integrity and honesty with the Australian people, which I have no doubt is taken very seriously by my colleagues on the National Cabinet. I'm going to go from the back and forward.

JOURNALIST: [inaudible] In France, millions of people signed up within a week of Macron's announcement. And the reality is that we still do have a fair bit of hesitancy among the community. Wouldn't making some kind of concrete announcement about what those passports might look like in the future act as a carrot for people who are eligible and hesitating or delaying. And is the reason the Government hasn't perhaps pushed as hard for this as they could have because of the views of some of your coalition colleagues who are dead set against any form of vaccine passport?

PRIME MINISTER: No, I wouldn't say that. I remember when I first raised this concept some months ago when I was in Queensland, there were many views that are against it and they weren't all in the Parliament. Most of them were actually outside the Parliament, indeed, some of them were in the media.

But my point is this. What you're raising is an important matter. At our meeting last Friday, we agreed in the plan, Phase B of the plan, is that if you're vaccinated, you can be exempt from various restrictions that might otherwise apply because of public health reasons, because you've taken steps to protect your health and the health of those around you. If you're not vaccinated, you present a greater public health risk. And so this is about managing public health risks. That's what it is. It's common sense. It has the added advantage that, of course, if you are vaccinated, then being exempted from some of those restrictions is obviously an attraction. And that's why the Northern Territory, Victorian and Tasmanian governments are working together to bring back a proper list of options for the Premiers and Chief Ministers and I to consider which go to the issues you're talking about.

And yes, I agree, being able to articulate what they are is a good idea. But we've got to work through them and ensure that the states and territories are supportive of those because they're the ones who have to do it. As a Federal Government, I can't restrict someone going or allow someone going into a sports stadium, or a venue, or even coming into this building. What has to happen is state public health orders to support those issues legally. Similarly, I can't make it the law for someone to require of a customer to declare their vaccination status or to make it compulsory for someone to be vaccinated. These things are done through public health orders at a state and territory level. So working together to define what they are is incredibly important. John Howard made a very good point on the weekend. The states don't have any more powers than they've ever had. They've just never been enlivened in the way that they have through this crisis. They've always had absolute control over public health in this country. But this once-in-100-year pandemic, I think, has shone a spotlight on that and those powers are enlivened through that process, not through any other process.

JOURNALIST: You just said Australians don't want to be paid off to receive the vaccine. Does that mean you'll be discouraging vaccine lotteries at any point?

PRIME MINISTER: We still remain open, and General you might want to comment on this, we've looked at all of these and General Frewen has already given you a comment on that. I think there's a big difference between something like that, a big difference, just not a fiscal one. I mean, the fiscal difference is pretty huge, I've got to say. And we've had lots of private offers of how things like that might work. And General Frewen and his team have looked at that. But the primary reason why Australians are going to do this is because Australians know that it's good for them, their family and their country. And I intend to respect that. I intend to acknowledge that. Because that's what I've been backing the whole time to ensure that Australia can come through in the way that we are. So we'll look at all of those issues. But to think that Australia needs to get paid off to do the right thing for their health, that's just not how Australians think. Because we have a very good vaccination history in this country. People do get it. We need to be careful to ensure that we follow an Australian way here consistent with our values and our approach, because that's what has worked for us all the way through. And I'm going to keep backing Australians on that and believing in them and not issue a vote of no confidence in them. But General?

LIEUTENANT GENERAL JJ FREWEN, COORDINATOR GENERAL OF OPERATION COVID SHIELD: Look, we've had more than 12.6 million doses administered now. We're having record days nearly every day now, more than 1.1 million doses across a seven day period. We're getting more than 200,000 doses a day on weekdays. We've had over 100,000 doses a day last Saturday. So Australians are coming forward right now. It's the right thing to do. It's important for the protection of all people in Australia and it's important for the nation to build the resilience we need going forward.

PRIME MINISTER: Over the back, then we've got time for a couple more. We have to be out in about five minutes.

JOURNALIST: Prime Minister, just following on Clare's question on Gladys Berejiklian's 50 per cent goal. Mark McGowan has attacked her over this, says the 50 per cent rate would be contrary to Friday's National Cabinet agreement. In your view, Prime Minister, would Gladys Berejiklian opening up after 50 per cent vaccination rate be contrary to National Cabinet's Friday agreement?

PRIME MINISTER: I think you're talking about two different things. They're two different things. We are talking in one instance about a National Vaccination Strategy where short, sharp lockdowns are the response during the suppression phase before you move at 70 per cent into the next phase where that isn't as necessary or at all necessary. And certainly almost completely unnecessary once you get to 80 per cent. That is a separate issue to how you come out of a lockdown you're already in. Now, coming out of a lockdown you're already in depends on the success of the lockdown in bringing the number of cases infectious in the community down to a level where they can be suppressed and contained. That is the goal the New South Wales Government is working towards. And when they believe they're in a position where they can confidently say they can do that, then I expect the lockdown to remain in place. So I think we need to be careful that we're not mixing two issues here. This is not a vaccination rate to break out of an existing lockdown. This is a vaccination rate that enables Australia as a country to move from Phase A, to Phase B, to Phase C. So I think we've got to avoid sort of phoney conflicts here. Paul is there anything that you want to add to that? No? OK, I think we'll just keep going then.

JOURNALIST: We've actually heard quite a bit from people who are struggling to get a vaccine appointment in the cities and in regional areas, they're on the phone for hours trying to actually get vaccinated. Obviously, that's your aim here. Why is that happening? A software developer on the weekend managed to put together an aggregator of booking sites within the space of a weekend. Why can't the Federal Government do that?

PRIME MINISTER: That already exists, and General Frewen might want to speak. And there's that one. There's also one called hotdoc.com.au, which is also based on the engine that was developed by the Federal Government as well. So this already exists. It's already there. It's already there. But you make an interesting point about the fact that there seems to be strong demand for the vaccine. So when you have strong demand for the vaccine, I'm not sure why you have to pay people.

LIEUTENANT GENERAL JJ FREWEN, COORDINATOR GENERAL OF OPERATION COVID SHIELD: So, the eligibility checker refers you often to state and territory booking systems as well. And there is variance in the state and territory booking systems. We're working closely with the states and territories constantly to try and refine best practise across those systems. But I've also seen examples of next day bookings. I mean, there are many opportunities for AstraZeneca right now within days. So it is variable, but we're working to to get it as consistent as we can.

JOURNALIST: Prime Minister, question for Professor McVernon, just in regards to the low level restrictions that will start to be in place once we reach that 80 per cent vaccination target. Are masks included in that? In what kind of circumstances do you expect that people will continue to wear masks in Australia? And for how long for? And just a question, you mentioned that there would be a reorientation in strategy around the 20-39 year old group. Can you elaborate a bit more on that?

PRIME MINISTER: Well, I might get General Frewen and Professor Kelly to talk about the latter point. But Professor McVernon?

PROFESSOR JODIE MCVERNON, DOHERTY INSTITUTE: So on the low restrictions, these are basically bundles of interventions that have been applied in Australia according to different strengths of coverage and masks have or haven't been part of that strategy around the world. Most modellers will not actually believe they can quantify the benefits of masks per se, because apart from anything else, a lot of important transmission occurs in households and people clearly don't wear masks there. But other than that, they are overlaid with other sets of restrictions. So the types of restrictions that we've described and consider in terms of the transmission potential are really around something where there are no stay at home orders, there are some social distancing rules and the two square metre rule, there'll be caps on numbers of people in stadiums and workplaces and things like that. They're the sorts of settings that often we see as we, you know, come back out of lockdowns of having still some level of spacing of people in the community but without full lockdown. And masks are often an adjunct to that and it's really impossible analytically to tease apart what masks contribute to that. But they are clearly important in helping people remember that there are threats out there and they'll be implemented according to public health orders at the time. Thank you.

PROFESSOR PAUL KELLY, CHIEF MEDICAL OFFICER: The task was, as Professor McVernon has said, to come up with these bundles. That was useful for the Treasury modelling so that they could cost some of those things as well. And masks have generally become part of those, of each of those modules actually.

PRIME MINISTER: It's not prescriptive to that level, in terms of your question.

JOURNALIST: [inaudible] of the strategy. That's what Professor McVernon said.

PRIME MINISTER: On the 20 to 39s, well General Frewen may want to comment on that. I mean, one of the lessons through this process, as Professor McVernon indicated in her presentation, was that at the commencement of this program, it has been rightly the priority to deal with those who are most vulnerable in the community. And so whether it's been in aged care facilities and things like that, well, the fact that we've moved on that means that what we're seeing in Sydney is not what we saw in Melbourne last year. But as time has gone on, and we are increasingly confident as time has gone on, as we've gone into May and into June about the impact of the vaccines on transmission, that now enables us to move to the next phase of the strategy and seek to bring more of those younger populations in sooner. And I'll ask General Frewen to comment on that.

LIEUTENANT GENERAL JJ FREWEN, COORDINATOR GENERAL OF OPERATION COVID SHIELD: Yes, look, I've developed a campaign plan which is really about managing supply with distribution nodes and then encouraging people in Australia to turn up to get vaccinated. That campaign plan is responsive to strategy. It also sits over events like hotspot outbreaks and those sorts of things. The shift in strategy here that's been spoken to, the idea that we do need to provide more focus on key transmissibility groups, that is absolutely able to be accommodated within the campaign plan. And we're looking to bring on 30 to 39s, which is the next highest priority, as one of the key transmissibility groups from the end of this month, start of September. 

JOURNALIST: PM, you said the Labor idea for a cash payment is a vote of no confidence in the Australian people. But is it really that big a departure from the no jab, no pay for parents when you've got a kid in childcare or to get Family Tax Benefit A, you've got to have your kid vaccinated. So already there's a financial incentive. And if you get to the end of the year where you can't shift that last five, 10 per cent, why not? Would you be open to looking at an incentive like this?

PRIME MINISTER: Well, the incentives the Government has been considering through Operation COVID Shield are matters that General Frewen has been looking at. But it doesn't support cash payments of that nature. And no I don't think there's an equivalence between those two. I know others have suggested that. And as the person who put that in place, I can tell you why we did it. We did it because we didn't want unvaccinated children mixing with those who were vaccinated for those conditions. It wasn't done necessarily as an incentive. It was done as a protection, as a protection for those children who were in those childcare facilities. So there was a very different task. I mean, the social services lever was used in that instance to deliver on that outcome, which was very effective in protecting children from going into those childcare centres. Now, many of those who are very opposed to vaccinations, they just didn't put their children in childcare facilities. That's their right. That's their right. We already have a very high rate of child immunisation. So I wasn't seeking to massively increase child immunisation rates because Australia already has high child immunisation rates. It wasn't about increasing the rate. It was about ensuring that others didn't put those children at risk. And that's why we took that decision. So it is very different. I know that in other countries they think of other things, but I'll tell you this as we wrap up. Australia is making its own way through this pandemic with enviable success. We are going to be able, I believe, before we get to the end of this year, based on what is being achieved and what I've seen from Australians, to get where we want to go. And we're going to get there with one of the lowest death rates from COVID in the world, with one of the strongest economies in the world to come through COVID, and a vaccinated population that is achieving the marks that we wish it to achieve. And that is the triple gold that Australia is looking for. Thank you very much.