Covid 19 Vaccines and the Australian health care state.

Objectives: Australia had one of the most successful early responses to the COVID-19 pandemic. Border closures and effective public health responses to outbreaks kept infection and death rates to amongst the lowest in the world. The strategy was premised on an eventual escape through the development and availability of vaccines. While effective vaccines appeared earlier than many expected, Australia's the next stage of crisis management stalled. Vaccination rates were, in mid-2021, one of the lowest in the OECD. By the end of 2021, however, Australia had a comparatively high vaccination rate. This paper accounts for this paradoxical situation. Methods: The analysis uses Moran and Tuohy's concept of the 'health care state' to show how interlocking elements of consumption, production, governance and statecraft created the conditions for Australia's contradictory response to the crisis. Results: The paper locates problems commonly attributed to 'leadership failure' in an analysis of the evolving dynamics of the Australian healthcare state and the governance regimes concerning collective consumption, the health professions, and technologies. Vaccine supply was delayed by the Federal government's preference for local production. The initial problems of the vaccine rollout arose from a failed experiment with outsourcing, initiated at the height of the crisis. Conclusion: Australia's ultimate success in achieving high vaccination rates emerged from the agile stability embedded in its health care state. This delivered where 'market inspired innovation' had failed.