Borders and boosters: what tools should we really be using against COVID in 2023?

Australia has entered the next year of the pandemic with very few restrictions – unless you’re coming in from China.

People with COVID-19 are now no longer required to isolate, and masks and social distancing have been dropped in most areas.

Meanwhile, vaccine uptake has slowed to a crawl. While Australia’s initial vaccine uptake was very high, with 96% of the eligible population receiving two doses, booster doses have received less enthusiasm.

As of the first week of January, 72.4% of eligible Australians have received a third dose, while 44.2% have received a fourth dose. Numbers have stagnated in recent months.

Would higher uptake of boosters lead to fewer hospitalisations and deaths, or are there other tools available?

Read more: Death toll from COVID-19 “much higher” says WHO

“I think that the issue at the moment is more around general common sense public health activity,” says Associate Professor Emma Miller, an epidemiologist at the University of Adelaide’s Stretton Institute.

While vaccine uptake is good, says Miller, masks and distancing are both more likely to “give us bigger bang for our buck”.

“It actually doesn’t cost anything – that is, encouraging people to wear masks when they’re in an enclosed space, particularly in a crowd, encouraging people to observe social distancing where possible, and it’s also around encouraging people to get those vaccines.”

Should you get a fourth dose? 

A fourth dose of a COVID-19 vaccine is recommended for people over 50, or people with health conditions that make them vulnerable to COVID-19.

People aged 30 to 49 are eligible but not specifically recommended for their fourth dose.

People under 30, without underlying conditions, are currently still ineligible for a fourth dose.

The Australian Technical Advisory Group on Immunisation (ATAGI) doesn’t recommend a fourth dose for those under 30 as “it is unclear whether the benefits outweigh the risks in this population”: specifically, the small risk of myocarditis and pericarditis from vaccination, compared to the risk of severe COVID-19 in a healthy young adult with three doses of a vaccine.

“The evidence is not there that it would be helpful for people in that particular group,” says Miller.

“ATAGI has got to come up with the right formula in terms of who’s eligible for those vaccines. You’ve got to start thinking about costs versus benefits, and if we’re going to push that to those younger people that are already reluctant, that in fact might do more harm than good.”

Miller believes  that reintroducing restrictions on people infected with COVID-19, and requirements to take and report tests, would likely be effective measures as well.

Testing travellers from overseas

The Australian government has also recently announced that travellers from China will need to get a COVID test two days prior to coming to Australia, as China relaxes restrictions.

“It’s actually quite reasonable – but the same could be said for every other traveller coming from anywhere,” says Miller.

Since plenty of countries are experiencing surges in cases, and (like Australia) dropping surveillance measures like test reporting, Miller says that it would be more sensible to expand the tests rather than single out one country.

“If we’re going to talk about introducing traveller predestination tests, fine. There’s no point in doing that unless you’re doing it for everyone.”