Blood clot cause, risks, chance of death and benefits

The death on Thursday of a 48-year-old woman from New South Wales, who developed serious clotting very soon after receiving the AstraZeneca vaccine, has again raised serious concerns about its safety.

Authorities are racing to investigate the exact cause of her death, which occurred in the intensive care unit of John Hunter Hospital, five days after her first dose.

She was reportedly a diabetic but in otherwise good health.

While the government has changed its advice, that people under 50 should not get the jab, its deployment continues among older and vulnerable populations.

Earlier this month, authorities in Europe confirmed a causal link between the vaccine and very rare but serious blood clots.

This is based on several dozen people developing them shortly after receiving the first dose – a condition scientists have labelled “vaccine-induced prothrombotic immune thrombocytopenia”, or VIPIT.

RELATED: Second Australian suffers blood clots after having AstraZeneca vaccine

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What is VIPIT and how dangerous is it?

As the name suggests, VIPIT is a kind of thrombocytopenia, which is the medical term for clotting.

A cohort of immunology, medicine and public health experts from Victoria University – Associate Professor Anthony Zulli, Professor Maximilian de Courten, Vasso Apostolpoulos and Maja Husaric – explained the condition like this.

“Thrombocytopenia is a condition whereby the numbers of thrombocytes – very small blood particles, or platelets – are markedly reduced,” they wrote in an article for The Conversation.

“Platelets form clots to stop bleeding, so when you don’t have enough platelets in your blood, your body can’t form clots. This can lead to excessive bleeding.”

Possible symptoms range from the mild to the serious, including severe headaches, seizures and visual changes, and abdominal pain.

“In rare cases of thrombocytopenia, clots can develop in the vessels draining blood from the brain,” Associate Professor Zulli and colleagues wrote.

That’s called cerebral venous thrombosis, or CVT, and forms in the venous sinuses of the brain – a system of veins between its tough outer layer, just below the skull.

It can block blood draining from the brain towards the heart, causing cells to break and seep into tissue, potentially leading to stroke.

Obviously, that’s quite dangerous and required critical medical care.

As of last week, the European Medicines Agency had received 170 reports of CVT in people who received the AstraZeneca shot.

RELATED: World Health Organisation’s chilling warning the COVID-19 pandemic is far from over

What’s happening with the AstraZeneca vaccine?

As Associate Professor Zulli and his colleagues explained, the vaccine developed by AstraZeneca simulates antibodies to mount a defence against the virus, specifically by attacking its spike protein, or the thing COVID-19 uses to attach to cells in the body.

“But in some people, the AstraZeneca vaccine seems to produce antibodies that react with platelets, making them stick together, leading the blood to clot,” they wrote.

“This in turn reduces circulating platelet numbers, and hence the thrombocytopenia.

“These antibodies are similar to those found in some people on a blood thinning drug called heparin. The immune response to heparin generates antibodies that bind to platelets.

“This can lead to blood clots in some people, called heparin induced thrombocytopenia. As many as one in 20 patients receiving heparin develop thrombocytopenia.”

It seems that VIPIT occurs between four and 20 days after a person receives the AstraZeneca jab.

As for why, that’s something experts around the globe are urgently trying to figure out.

Is it a rare side-effect?

In terms of the COVID-19 vaccine, VIPIT is an extremely rare side-effect.

Analysis of data by the Thrombosis and Haemostasis Society of Australia and New Zealand put the chances of VIPIT at about one in 500,000 people who’ve received the AstraZeneca vaccine.

In Australia, there have been two reported cases of blood clotting among the 700,000 recipients of the AstraZeneca vaccine.

Data out of the US puts the risk of naturally occurring blood clots at one in 30,000 adults every year.

A report released by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) last week broke down the latest available data, as of March 31.

More than 20 million doses of the AstraZeneca jab had been given at that time, and 79 cases of blood clots had been reported.

That’s about one in 250,000 people, or four in a million, at risk overall.

Of the 79 cases, 44 developed CVT and 35 had thrombosis in other major veins. Sadly, 19 people died.

Dr June Raine, chief executive officer of the MHRA, said: “No effective medicine or vaccine is without risk.”

In fact, the condition can be sparked by some 300 common medicines, from the contraceptive pill to penicillin and over-the-counter painkillers.

Who’s most at risk?

It must be stressed that the number of cases of clots is extremely small in the scheme of things, and so conclusions are far from concrete.

Women under the age of 65 have predominantly been impacted. It also seems that there are issues with the first dose only – not the second.

Instances of blood clotting is less likely in older groups, the data suggests.

For example, based on the UK reports, for those in their 60s and above who get the AstraZeneca jab, 0.2 people per 100,000 are at risk of VIPIT.

By comparison, we know that for every person in that age bracket who develops a clot, another 70 will wind up in intensive care in a month from COVID-19 infections.

What else can cause this kind of response?

Much has been said in recent weeks about the significantly higher risk of clotting from the contraceptive pill.

Experts estimate about one in 10,000 women who take birth control will develop a blood clot, which is obviously a significantly higher risk.

Pregnancy also carries a high risk of blood clots, with women carrying a child five times more likely to develop them than those who aren’t pregnant.

Smokers are also more likely to suffer clots, while minimal movement over long periods of time – such as on long-haul flights – also comes with high risks.

Associate Professor Ben Chan, an expert in global health at the University of Toronto, told Global News the chances of getting a blood clot after an AstraZeneca jab is the equivalent of being hit by a car and dying.

“Yes, these are risks, we should be aware of them, but we need to put them into perspective compared to the daily risks that we have in our lives around us,” he said.

“Just about every medication that we take has some potential for side effects, and all those medications have great advantages to us. They help us keep alive.”

In fact, a COVID-19 infection itself is significantly more likely to cause blood clots than the AstraZeneca vaccine, a study has found.

Researchers at Oxford University – that’s where the vaccine was developed, but these scientists aren’t affiliated with that department – determined the risk is about eight times greater.

“There’s no doubt that COVID is a much greater risk of this (clotting condition) than any of the vaccines,” Professor Paul Harrison, a co-author of the study, said upon its release on Friday.

What about the risk of death?

The risk of developing VIPIT after having an AstraZeneca vaccine is extremely rare – but the condition itself is also very serious.

Based on reports so far, about 25 per cent of those who have developed VIPIT have died, Associate Professor Hassan Vally from La Trobe University said.

“To put it in perspective, this puts the risk in the same order of magnitude to the average risk of dying if you complete a marathon, go scuba diving, or rock climbing,” he wrote for The Conversation.

Do the benefits outweigh the risks?

When reports first emerged about a potential link between the AstraZeneca jab and blood clots, authorities in most parts of the world insisted the benefit of the jab outweighed its risk.

That remains largely the case, although some countries have entirely suspended the rollout of the vaccine for younger people.

But, based on the data from overseas, it’s still true that the benefit from avoiding potential illness or death from a COVID-19 infection significantly outweighs the very rare identified risks of the AstraZeneca vaccine.

“We make these sorts of calculations every day in all aspects of our lives,” Associate Professor Vally said.

“When we decide to get in the car, we know there’s a risk associated with driving. But we assess the risks are worth taking as the benefits of getting where we want to go quickly are worth it.

“Mostly, we make these calculations without being consciously aware we’re doing it. Sometimes the parameters underlying these calculations are easy to grapple with — but sometimes they’re more nebulous.”

RELATED: New variants of COVID-19 are behaving like new viruses and may derail vaccine hopes

However, Associate Professor Vally said weighing up the risk isn’t simple, nor black and white, and depends on a range of factors – including age, health, seemingly gender, and where you live.

“While it’s all well and good in some countries to say you’re more likely to get very sick with or die from COVID than experience a complication from the vaccine, in Australia we have next to no COVID, so the risk of adverse outcomes from COVID is much lower,” he said.

“This needs to be factored into the equation.

“We also have different strains of the virus, which can vary in how infectious they are and how sick they might make you. This also needs to be added to the mix.”

What are the implications?

We’ve already witnessed the consequences of the very rare but serious risk of blood clotting from the AstraZeneca COVID-19 vaccine.

The Federal Government shifted its advice last week, that Australians aged under 50 for the most part should avoid getting the jab and instead wait for the Pfizer vaccine.

Australia has put most of its eggs in the AstraZeneca basket, relying on the local mass production of doses to provide what’s needed to inoculate the population.

Now that millions of people won’t be getting it, the rollout is significantly delayed and all former targets have been abandoned.

Ordering more Pfizer doses is tricky due to extremely high global demand – a top-up for 20 million more jabs was rushed through last week, but it’s not close to being enough.

On top of that, actually getting the supply onto Australian shores is even harder because there simply aren’t any to ship here.

Those Aussies hoping for a shot in the arm sooner rather than later will be disappointed.

When it comes to those aged over 50 who are still encouraged to get the AstraZeneca jab, there’s now a risk of low confidence about its safety, Professor Adrian Esterman, an epidemiologist at the University of South Australia, said.

“The government needs to reinstate confidence and convince over 50s the AstraZeneca vaccine is safe,” he wrote the The Conversation. “This will require a major effort using Australia’s best marketing brains.”

The government also needs to get cracking on approving another vaccine, developed by US biotech firm Novavax, which is in final stage trials now and shows strong efficacy, he said.

“This would safeguard us against any further issues with the AstraZeneca vaccine, and the Novavax could eventually replace AstraZeneca because of its much higher efficacy.”

Australia has ordered 51 million doses of this jab, but it won’t arrive until the end of the year – and it still needs Therapeutic Goods Administration approval.

What should you do?

To start with, if you’ve already had the first dose of the AstraZeneca vaccine without any adverse effects, experts unequivocally agree that you should have the second.

As with all matters related to personal health and wellbeing, you should seek the advice and guidance of your GP about what vaccine is right for you.

For example, the government advice for people under 50 to get the Pfizer jab instead does not include people with pre-existing medical conditions or who are part of other vulnerable populations.

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NSW Premier Gladys Berejiklian waiting for information on whether woman’s death was linked to AstraZeneca coronavirus vaccine

NSW Premier Gladys Berejiklian says she’s waiting to hear back from federal health authorities investigating whether there is any link between a woman’s death and the AstraZeneca coronavirus vaccine.

The death of the woman in her 40s has prompted the Therapeutic Goods Administration and NSW Health officials to seek clinical information and test results as they try to figure out what caused it.

“It has not yet been established whether there is any link between the COVID-19 vaccine and the tragic death reported by NSW health officials,” the federal health department said in a statement on Thursday.

On Friday morning Ms Berejiklian did a round of interviews on morning shows and said she wasn’t privy to any more information about the case than the public was.

“I know as much as you do,” she told the host of the Today show.

“All I do know is that the federal authorities are looking into these matters to see if there is that link. And in the meantime we just extend our heartfelt condolences to the family and loved ones during this difficult time.”

Appearing on the Sunrise program moments later, Ms Berejiklian said she will update the public as soon as more information becomes available.

“I want to assure everybody that whenever we get information that is relevant, we always make sure we convey it as soon as we can, but there’s nothing further we have to update,” she said.

“We’re relying on the federal authorities (to say) if there is a link or not, whether it’s a horrible coincidence.”

The federal health department said there had been two confirmed cases where Australians who had received the AstraZeneca vaccine had been sickened with a rare blood clotting disorder known as thrombosis with thrombocytopenia syndrome or TTS.

That’s out of a total of more than 700,000 people who have received that type of vaccine.

In the UK, where the vaccine rollout has come much further, the ratio of blood clotting cases to jabs is even smaller.

At the beginning of the month the BBC reported that only 30 blood clotting cases had been reported out of a total of 18 million Astra Zeneca vaccine recipients.

Despite the low risk, the Australian Technical Advisory Group on Immunisation (ATAGI) advised the federal government last week that the AstraZeneca vaccine should mainly be given to people over 50.

Younger people can still get the vaccine, but the consent procedures around the risk of side effects will be updated.

The advice threw the Scott Morrison government’s vaccine plans into disarray and prompted the Prime Minister to scrap an October target to have the entire willing population vaccinated, saying the situation is too volatile to commit to a timeline.

Mr Morrison bet heavily on the AstraZeneca vaccine and has ordered more than 50 million doses of the product, most of which will be made locally in Victoria.

The Pfizer-made vaccine that is considered safer has not been available in large enough quantities to meet Australia’s needs. But the Prime Minister has put orders in for some 40 million doses that the government hopes will arrive by the end of the year.

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WHO warns COVID-19 strains from Brazil and UK ensure pandemic is far from over

It’s now more than a year since the severity of the coronavirus pandemic first made itself clear, plunging most the world into lockdown and pushing countless nations to the brink.

Here in Australia, that all feels like a distant memory now, thanks to virtually no cases of COVID-19 and a rapid return to normal, or at least a new but familiar version of it.

However, a leading expert has issued a stark warning “the pandemic is nowhere near finished” and the worst may be yet to come, with infections “surging” around the globe.

And even with a closed international border, Australia can’t be assured we’ll dodge it, as past leaks from hotel quarantine have demonstrated.

Speaking at a gathering of the Royal College of Physicians in Edinburgh in the United Kingdom on Wednesday, Dr David Nabarro, the World Health Organisation’s special envoy on COVID-19, said new variants of the virus were wreaking havoc.

“Each week we have seen four and a half million cases being reported and know those are an enormous underestimate,” Dr Nabarro said.

“And we are still seeing a really significant number of deaths – nearly three million. What I want to stress is that the pandemic is surging forward everywhere.”

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So far, three variants of coronavirus have seen epidemiologists sound the alarm, but Dr Nabarro warned it’s inevitable more and more new strains will develop.

The warning came as scientists made a devastating revelation – the deadly P1 variant that originated in Brazil, responsible for a surge in serious illness and deaths there, is now itself mutating.

Experts examining the strain fear it is rapidly changing in ways that could make it resistant to vaccines.

RELATED: COVID-19 variants infecting greater numbers of young people

Horrific new waves sparked by variants

Right across the globe, in the developed world and developing nations, there’s a resurgence of COVID-19 cases sparked by new variants of concern.

They’re more infectious and cause a more severe illness that lasts longer and is considerably more likely to be fatal.

Unlike the original virus, the strains are seeing young and otherwise healthy people fall ill in large numbers.

Take India, which has recorded more than 180,000 new cases this week alone, bringing its total infection number to a staggering 13.9 million.

At least 172,000 people are dead, but virtually everybody agrees that figure is grossly conservative.

“This sheer tsunami of cases has already overwhelmed the healthcare infrastructure in the state,” Dr Shashank Joshi, part of the COVID-19 task force in Mumbai, told The Sun.

“This time we are seeing younger people between 20 and 40 getting seriously affected and even children are now being hospitalised.”

RELATED: Pfizer vaccine could be less effective on South African COVID-19 variant

Scientists fear the rapid rate of infection and spread in India will see potentially devastating mutations of the virus emerge.

Meanwhile, Brazil is in the midst of a devastating surge in new cases, illnesses and deaths, and the country’s public health institute has discovered mutations of the local P1 variant.

“We believe it’s another escape mechanism the virus is creating to evade the response of antibodies,” researcher Felipe Naveca told Reuters.

Vaccines developed to fight COVID-19 target the spike protein of the virus, which it uses to enter and infect cells in the body. Alarmingly, it’s in the spike that Brazilian scientists have discovered mutations.

“This is particularly worrying because the virus is continuing to accelerate in its evolution,” Dr Naveca said.

The P1 strain is already at least 2.5 times more infectious and is more resistant to antibodies.

Its discovery in parts of Europe and Asia, as well in dozens of American states, has sparked panic.

Those regions are already grappling with the horrific impact of another mutation, the B117 variant, known as the UK strain.

It has been attributed to a surge in new cases in parts of the US and is now the most dominant strain in the country, the Centers for Disease Control confirmed last week.

That’s concerning because the strain is between 50 and 70 per cent more infectious than the original strain.

It has already torn through large parts of Western Europe and is behind dramatic surges that sparked renewed lockdowns, including in France.

Things will get worse before they get better

The UK has turned a very sharp corner in recent months, crushing the curve of new cases, illnesses and deaths, thanks to a combination of tough lockdowns and the rapid rollout of vaccines.

But Dr Nabarro said the hard-hit country is bucking the global trend.

He also warned against complacency, saying a localised outbreak could quickly spread like wildfire, causing a new crisis.

The world is pinning its hopes on the escalated deployment of vaccines bringing the beginning of the end of the crisis.

“I have to stress that I am not 100 per cent sure that the world is going to find it too easy to vaccinate itself out of this pandemic,” Dr Nabarro said.

The reason for that is the emergence of these new variants of concern that can escape the protection of current vaccines.

For example, a third variant of concern – the B1351 strain, or the South African mutation – appears to break through the defences of the robust Pfizer jab.

But yesterday, Moderna announced it has developed an experimental ‘booster’ of its vaccine that early testing shows is successful in suppressing the B1351 strain.

There’s every chance future mutations could be even more resistant to antibodies in vaccines, leaving the world to play a dangerous game of catch-up.

“With very large amounts of virus around, there will be a regular arrival of new variants that are particularly troublesome,” he said.

Dr Nabarro added: “That variant problem is going on and on and on as long as we have got a lot of virus around.

“For anybody to say that they are safe because they are vaccinated is more hope than probability.

“We should expect more variants to emerge and escape vaccine protection, that is inevitable, and so globally we should anticipate that this pandemic is going to go on roaring in parts of the world where there are large numbers of people infected.”

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Drug-induced deaths in Australia – five fatalities a day from cocaine, opioids, amphetamines

A steadily worsening scourge killed an estimated five Australians every day in 2019, with most of the fatalities occurring in relatively young men.

Across the board, the number of deaths and the rate of death has been steadily increasing each year for 15 years, despite huge amounts of money being spent to prevent tragedy.

A report released today by the National Drug and Alcohol Research Centre at UNSW found there were 1865 drug-induced deaths in Australia in 2019, which is the equivalent of five fatalities every day.

“This is the fifth year in a row where the number of deaths is higher than the earlier peak in the late 1990s,” Dr Amy Peacock, program lead for the Drug Trends program, said.

The preliminary rate of death is 7.4 fatalities per 100,000 people, which has been increasingly steadily now since 2006.

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The report found opioids, including both prescription medications and heroin, were again the main substance in drug-induced deaths in 2019, linked to 1121 fatalities.

Of those, 873 deaths were deemed to be unintentional – or an accidental fatal overdose.

“This is the first year the number of opioid-induced deaths involving heroin (474) has surpassed that of natural and semisynthetic opioids (460),” Dr Peacock said.

The total number of deaths in 2019 linked to opioids is almost on par with the number of people killed in the worst years of the heroin epidemic in Australia in the late 1990s.

Distinct patterns emerging in the data

When it comes to other substances, the rate of deaths involving amphetamines was four times that recorded in 2009, while cocaine-induced fatalities more than doubled between 2016 and 2019.

A breakdown of the data shows some other distinct trends.

Two-in-three deaths occurred among men, with the highest rate of fatalities in the 45 to 54 age bracket, followed closely by those aged 35 to 44.

A look at trends over time shows younger Aussies are increasingly less likely to die of a drug-induced death, while older people are more likely.

“In the late 1990s, deaths were driven by those in the younger age. The rate of drug-induced deaths among the 25 to 34 age group has since declined.

“By contrast, the greatest increase over time has been in the 45 to 54 age group. Indeed, (this age group) overtook all other age groups in respect to the number and rate of drug-induced deaths in 2019.

“Another large increase has occurred in the 55 to 64 age group.”

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While the mortality rate among people aged 15 to 24 has remained low for the past 15 years, there has been a slight uptick in recent years, from 2.7 deaths per 100,000 people in 2018 to 3.5 deaths per 100,000 people in 2019.

The highest rate of drug deaths was in Western Australia – for the third consecutive year.

In 2019, the rate of drug-induced deaths was similar in major cities, inner regional and outer regional areas, and the lowest in remote and very remote areas.

At least one psychosocial risk factor for mortality – such as unemployment or underemployment, homelessness, or a social and family support issue – was present in one-in-four unintentional deaths and three-in-five intentional deaths.

The most frequent risk factor identified in both unintentional and intentional deaths was a history of self-harm.

But perhaps the most alarming trend in the data is the consistent annual increase in deaths.

“There was a peak in drug-induced deaths in the late 1990s, followed by a decline in the early to mid 2000s,” the report outlines.

“Since 2006, drug-induced deaths in Australia have increased. The number of deaths recorded each year from 2015 to 2019 has been higher than the number observed during the earlier peak in deaths in the late 1990s.”

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Magda Szubanski’s tweet about Jenny Morrison, the PM’s wife, motive explained for Handmaid‘s’s Tale attack

Popular comedian Magda Szubanski has explained why she attacked the Prime Minister’s wife and her Christian faith in a controversial tweet at the weekend.

The Kath and Kim star and best-selling author has endured days of ferocious criticism over the social media pot shot, accused of “appalling” conduct.

In it, Szubanski not-so-subtly compared Jenny Morrison to the fictional religious extremist characters in the television series The Handmaid’s Tale.

Based on the iconic book by Margaret Atwood, the story is set in the dystopian future totalitarian nation of Gilead where single women are kept as baby-making slaves.

Married women are subservient and do not work, wearing plain coloured clothes and serving the whims of their husbands.

Now, Szubanski has doubled down, revealed her motive and said she believes real-life conservative Christians are “really going to come for me now”.

RELATED: Magda Szubanski cops ‘avalanche of hate’ from right-wing extremists

The controversy began when a photograph was released of Scott Morrison signing a condolence book for Queen Elizabeth, following the death of her husband Prince Philip, the Duke of Edinburgh.

In the image a sombre Mrs Morrison, dressed in black and standing in the background, watches on.

The photograph was tweeted by a well-known, left-leaning feminist group, which labelled it “creepy”.

“Good morning to everyone else to whom this feels creepy, chilling, terrifying, ominous, enraging, despairing and utterly, completely f***ing depressing,” the message read.

Szubanski shared the tweet and added: “I genuinely thought this was a photoshopped Handmaid’s Tale meme. But no. It’s 21st century Aussie life.”

The backlash was swift, with a string of Coalition politicians criticising Szubanski for going after the PM’s wife.

Several female politicians spoke out against Szubanski, with Liberal MP Nicolle Flint calling her tweet “appalling” and “deeply nasty”.

Magda reveals her motive for attacking Jenny

On Wednesday night, Szubanski appeared on A Current Affair to give her side of the story, saying her intention was to highlight the growing influence of ‘far-right Christians’ in political life.

“That was a mild way of drawing attention to the fact I do have concerns about, and trust me this is not about the majority of Christians, but the element of the far-right,” she said.

“And – they are really going to come for me now – I think that is a concern.

“I think that is quite legitimate to say in this country. I don‘t like extremes of any kind, is my stance.”

The Morrisons are evangelical Christians and prominent figures at their local church, Horizon – part of the Hillsong group – in Sydney’s Sutherland Shire.

The pair met at a Christian youth group. They are open and proud of their devout faith.

Szubanski did not apologise for her original tweet, instead doubling down, saying: “why you would put something that looks like the Handmaid’s Tale out as a photo op?”

She said she’s normally “extremely restrained” on social media, but felt compelled to share her views.

“In terms of the increasing presence of the religious right in politics in this country, then I will say something,” she said.

She also claimed that the controversy about her tweet was manufactured to distract from former Australia Post boss Christine Holgate’s appearance before a Senate committee.

Mr Morrison has faced direct criticism over his treatment of Ms Holgate, who he savaged in parliament for awarding several high-priced Cartier watches as executive bonuses.

She claims to have felt bullied and driven to the point of suicide over the saga and the destruction of her career.

“I‘m becoming Twitter toughened and if you speak up, this is what’s going to happen,” Szubanski said.

“What stunned me was this was such a non-event, and non-comment. It was a comment about a photo that I genuinely thought was a meme.

“I was a bit staggered that I got drawn into this over such a nothing observation that thousands of people had already made on Twitter.

“I think it’s sort of a fact of 21st Century life. If you are at all a public person, you do get better at it, but it seems excessive as to what the actual tweet was.”

Before her appearance on the program, Szubanski took to Twitter again to defend herself against the backlash, insisting that Mrs Morrison is “fair game”.

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Threat Assessment Report 2021 outlines dire state of world after COVID-19 pandemic

A major new report released by intelligence agencies in the United States has painted a picture of a chaotic and potentially disastrous few years ahead for the entire world.

Significant global disruption sparked by the COVID-19 pandemic, which has had a year-long impact on not just health, but economies, societies and general security stability, is obviously front and centre.

But not far off in the background are equally alarming threats – great power competition among nations, the disruptive effects of ecological degradation and a changing climate, an increasing number of empowered non-state actors, and rapidly evolving technology.

The Annual Threat Assessment of the US Intelligence Community report, declassified for release on Tuesday, highlights how a perfect storm of terrifying factors have combined to produce a “diverse array of threats”.

It outlines a complex series of risks facing the west, and explains how those threats will likely clash with other dangers, raising the “potential for cascading events” in the near future.

It makes for unsettling reading and a stark reminder that those hoping for an imminent return to normal life post-COVID will be severely disappointed.

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Four main nations of concern

Considered the world’s modern-era global cop, keeper of the peace and defender of its allies, the US has long identified countries of concern in these reports.

This year’s assessment is no different, going into detail about four nations that pose a threat to the US, its interests and its allies – China, Russia, Iran and North Korea.

“Major adversaries and competitors are enhancing and exercising their military, cyber, and

other capabilities, raising the risks to US and allied forces, weakening our conventional deterrence, and worsening the longstanding threat from weapons of mass destruction,” the report states.

Rather than slowing down those efforts, the COVID-19 pandemic seems to have given something of a cover – a convenient distraction to advance nefarious causes.

Individually, and in some cases in partnership, these four countries have “demonstrated the capability and intent to advance their interests at the expense of the US and its allies, despite the pandemic”, the report highlights.

But its Beijing’s multi-faceted scheme to drastically grow its global domination that features prominently in the report.

“China increasingly is a near-peer competitor, challenging the US in multiple arenas – especially economically, militarily, and technologically – and is pushing to change global norms,” the report states.

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Its whole-of-government strategy to spread China’s influence throughout the world while simultaneously undercutting the might of the US will likely gather pace.

So too will its pointed attempts to “drive wedges between Washington and its allies and partners”.

At the same time, Beijing is increasingly showing off its military strength and political might in order to pressure its regional neighbours and other strategically important nations to bend to its will, the report states.

“In the South China Sea, Beijing will continue to intimidate rival claimants and will use growing numbers of air, naval, and maritime law enforcement platforms to signal to southeast Asian countries that China has effective control over contested areas.”

Similarly, China is pressuring Japan over contested parts of the East China Sea, the report stated.

“Beijing will press Taiwan authorities to move toward unification and will condemn what it views as increased US-Taiwan engagement.

“We expect that friction will grow as Beijing steps up attempts to portray Taipei as internationally isolated and dependent on the mainland for economic prosperity, and as China continues to increase military activity around the island.”

Generally, China will continue “pursuing its goals of becoming a great power, securing what it views as its territory, and establishing its pre-eminence in regional affairs by building a world-class military, potentially destabilising international norms and relationships”, the report states.

Meanwhile, Russia continues to push back against the US “where it can globally, employing techniques up to and including the use of force”.

“We assess that Moscow will employ an array of tools – especially influence campaigns, intelligence and counter-terrorism co-operation, military aid and combined exercises, mercenary operations, assassinations, and arms sales — to advance its interests or undermine the interests of the US and its allies.

“We expect Moscow to insert itself into crises when Russian interests are at stake, it can turn a power vacuum into an opportunity, or the anticipated costs of action are low.”

On Iran, the report describes the rogue nation remaining “a regional menace with broader malign influence activities”.

North Korea is labelled “a disruptive player on the regional and world stages” in the report.

RELATED: New footage reveals massive Russian military build-up on Ukraine border

How COVID is changing the world

It will be some time until the effects of the COVID-19 pandemic are behind us and no longer felt, the report warns.

Governments and societies around the globe will continue to be strained, “fuelling humanitarian and economic crises, political unrest and geopolitical competition”.

“No country has been completely spared, and even when a vaccine is widely distributed globally, the economic and political aftershocks will be felt for years.

“Countries with high debts or that depend on oil exports, tourism, or remittances face particularly challenging recoveries, while others will turn inward or be distracted by other challenges.”

The report adds: “The economic and political implications of the pandemic will ripple through the world for years.”

Coronavirus has also provided an opportunity for nations like China and Russia to benefit, including via what’s been dubbed “vaccine diplomacy”.

This influence-building could have broad social, political and security implications for years to come.

Another consequence of COVID-19 is the potential for other diseases to flare up in vulnerable populations, the report states.

“COVID-19-related disruptions to essential health services – such as vaccinations, aid delivery, and maternal and child health programs – will increase the likelihood of additional health emergencies, especially among low-income countries.

“As examples, the pandemic has disrupted HIV/AIDS treatments and preventive measures in Sub-Saharan Africa, as well as measles and polio vaccination campaigns in dozens of countries.”

Other major challenges facing the world

The threat assessment report delves into a range of other risks, from the changing climate to terrorism and organised crime.

On the environment, it outlines how ecological degradation and climate change will “continue to fuel disease outbreaks, threaten food and water security, and exacerbate political instability and humanitarian crises”.

Right now, much of the effects of a changing climate on America and its security are felt “indirectly in a broader political and economic context”, the report states.

But warmer weather will likely produce direct and immediate threats, it adds, via more intense storms and flooding, for example.

Elsewhere, surges in migration – which can threaten security and stability, place strain on vulnerable nations, spark illness and disease outbreaks, cause humanitarian disasters and more – will grow.

Central American populations particularly are likely to relocate rapidly, due to the economic fallout of the COVID-19 pandemic, coupled with environmental disasters like drought, hurricanes and other extreme weather.

In addition, regional conflicts in Afghanistan, Syria and Iraq continue to fuel humanitarian crises.

The report also details how organised crime gangs have adapted to the challenges to the drugs trade presented by COVID-19.

And it identifies Islamic State, al-Qaeda and Iranian militants as the biggest plotters of attacks against US people and interests, and to varying degrees, directly on the US.

“Despite leadership losses, terrorist groups have shown great resiliency and are taking advantage of ungoverned areas to rebuild.”

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Labor pledges $91m to reduce Aboriginal incarceration rates and reduce deaths in custody

A “seismic shift” has been proposed to reduce the rate of Indigenous people being locked up in prison as the number of First Nation Australians dying in custody continues to rise.

Thursday marks 30 years since the Royal Commission in Aboriginal Deaths in Custody handed down its landmark report but the anniversary has come to represent a day of mourning, with at least 474 Indigenous Australians killed in custody or police pursuits since.

The number of deaths can only decrease by reducing the horrific rates of incarceration, according to shadow spokeswoman for Indigenous Australians Linda Burney.

She said an elected Labor government would introduce a $91m suite of changes aimed at improving the disproportionate number of Aboriginals locked up in prisons.

First Nation Australians represent just 3 per cent of the country, but since the royal commission, the number of Aboriginals behind bars compared to the prison population has more than doubled from 14 to 30 per cent.

In some regions, that figure is closer to 90 per cent.

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The proposal will focus on improving the socio-economic influences that often lead to Indigenous Australians being incarcerated to reduce the likelihood of reoffending.

Ms Burney wants to do this by investing in 30 key communities across the country by boosting various services including rehabilitation services, family or domestic violence support, homelessness support and school retention initiatives.

The idea, which is supported widely by advocates and justice academics, is to address the cause of crime by adopting a holistic approach to figure out why the individual has committed an offence rather than slapping increasingly harsh punishments each time they enter the court system.

“We’re arguing that the most important thing is to look at the underlying factors that contribute to people being locked up,” Ms Burney told the NCA NewsWire.

“Things like intergenerational trauma, the amount of children who are put in the child protection system, overcrowding, lack of education and employment opportunities, and poor health.

“This package is not about having rose-coloured glasses, it is about looking at the reality and looking at evidence where we see things working.”

Ms Burney cited the community-led Maranguka Project in Bourke, NSW, where justice reinvestment has led to an “extraordinary reduction” in violence, juvenile reoffending and major crime categories.

The community has also reported an increase in youths staying in school to complete year 12 studies.

“The other thing is it looks at alternatives to custodial sentences,” she said.

“It doesn’t mean you’re soft on crime and there is no way in the world I would ever argue that violent crime should not be treated seriously. But for many Aboriginal people, the sentences are very short and the number of deaths we’ve seen happen on remand.”

Ms Burney therefore suggests a safer and more productive alternative to imprisonment would be ideal when the crime was less serious.

Another alarming statistic to emerge in the 30 years since the royal commission findings were handed down was the sharp increase in Aboriginal and Torres Strait Island women being imprisoned.

This cohort is the fastest growing prison demographic, with a frightening 90 per cent of those having experienced family violence.

Antoinette Braybrook, chair of Indigenous incarceration advocacy group Change the Record, said the rate of women thrown into jail meant “children are being ripped away from their mothers at stolen-generation levels”.

“And still women are not being supported to escape family violence,” she said.

“We call on governments to invest in our communities, our services and Aboriginal and Torres Strait Islander leadership to build strong and safe futures for our women.”

Ms Burney said this frequency of women ending up behind bars had a tangible knock-on effect for Aboriginal communities as children were taken from their homes as a result and left in a child protection system where they were statistically more likely to end up in the prison system.

“So there is a real connection,” she said.

“You can’t just talk about 50 custodies over here and child removal over there.

“It’s got to be looked at in a holistic way.”

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Scott Morrison flags ‘mass vaccination’ to get covid jabs back on track

Scott Morrison has flagged “mass vaccination options” for Australians aged 50 to 70 from June for the first time, raising hopes it could hold the key to getting the majority of Australians protected against COVID-19 by the end of the year.

The prospect of Australians lining up at sports stadiums and big clinics could become a reality by mid-year with the government racing to consider options.

The Prime Minister has previously dismissed calls for mass vaccination clinics arguing that it was unsuitable in the early stage of the rollout for vulnerable, elderly people in aged care.

However, after pressure from NSW to consider mass vaccination clinics in recent weeks he’s now flagging the option of vaccine “hubs” to ramp up the program from June for people aged 50 to 70. That could be extended to under 50s in the final quarter of the year.

“Equally there’s an option to work – and I’ve discussed this with at least one premier – about how mass vaccination could be an option earlier, say in June or July, for those over-50 groups that are in the balance of the population,” Mr Morrison said.

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Mr Morrison said the mass vaccination option – which would require a massive recalibration of the program – could hold the key to ramping up the rollout.

“We want to ensure we can get systems in place, to understand the risks associated with that, what resourcing is required and to be able to direct those programs as a national cabinet (meeting),” he said.

“That’s what the meetings are for.”

Stung by accusations of a “bungled” rollout, the PM abandoned a pledge to deliver a timetable to vaccinate all adults by the end of the year at the weekend.

But Mr Morrison hinted that may still be possible if mass vaccination clinics could be rolled out for those aged under 50 later in the year when extra Pfizer imports become available in the final three months of the year.

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“It’s important that we get people aged over 50, particularly those aged over 70, which is the target group right now, vaccinated, because they are the most vulnerable population, particularly as we go into winter,” he said.

“As we move into the second half of this year, when we were planning to move into the balance of the population, those between 50 and 70 and those of younger ages as well.”

The PM said the Pfizer vaccine deliveries will increase in the weeks and months ahead but the big imports of Pfizer and Novavax were expected in the final quarter of the year.

“So that will mean we’ll need to change our rollout to go to mass vaccination options, and that will have to be done in partnership with the states and territories,” he said.

“Now, if we can do all that then there is the possibility that can be achieved by the end of 2021. But at this stage, there are too many uncertainties.”

The PM also warned Australians that if international borders are reopened and the vulnerable vaccinated we may need to move to a “new normal” of tolerating some COVID-19 cases.

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“And if we want to treat COVID like the flu, then we have to have the same tolerance for COVID as we have for the flu,” he said.

“And people get the flu and there would be cases of COVID if the international borders were lifted, there would be cases and we’d have to be confident and comfortable that that would be in Australia’s interest to have potentially large numbers of cases of COVID, knowing that it would not lead to the horrific outcomes that we saw, in particular in Victoria, when the second wave ripped through particularly Melbourne.

“And so they are real legitimate questions that need to be worked through with states and territories. There’s a lot of focus on the daily number of cases, both by state governments, their chief health officers and their premiers, but also by the media.

“And so we would need to be, I think, of one mind that if we were to go to those steps later in the year or soon after, then they would have to be an appreciation that would come with case numbers for COVID in Australia. And we would have to be understanding of what that meant.”

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Virgin Australia launch​ triple Velocity points to compete with Qantas

Virgin is deploying a new triple points offer as it continues to wage war with Qantas to woo frequent flyers.

Between now and 25 April, any booking for a domestic flight with Virgin Australia will score triple the usual number of Velocity Points.

Velocity usually awards 5 points per $1 spent, so that figure rises to 15 points per $1 spent.

The offer applies to any flight from 1 June 2021 to 8 March 2022.

To score the triple points, you first need to activate the deal on Virgin’s site or through its app.

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While the coronavirus pandemic saw passenger numbers plummet to near zero, this year, Qantas and Virgin have both been fighting hard for a slice of the resurgent market.

Almost half of all Australians (49 per cent) plan to travel domestically this year, and 17 per cent hope to head overseas, according to Finder’s Consumer Sentiment Tracker.

The battle for frequent flyers is particularly intense, since loyal passengers often spend thousands of dollars every year on flights.

Already this year Virgin has done a “status match” to give higher-tier Qantas members equivalent status in Velocity, and it’s increased the number of Velocity Points that can be earned from Flybuys points.

Qantas has also offered status matches to other airlines, and recently ran a double status credits offer.

The war has also spread beyond flights, with offers of 100,000 bonus points for frequent flyer credit cards appearing from both Qantas and Virgin after a much weaker 2020 market.

The battle is good news for passengers, who can take advantage of offers through both airlines.

That’s a strategy I’ve been using all year, which has given me a huge stash of points to use with both airlines once international travel opens up.

On that front, Qantas still has the edge. Virgin hasn’t yet confirmed any plans for international flying.

When the New Zealand travel bubble opens up later this month, Qantas and Jetstar will both be options for Australians, but Virgin won’t be.

The airline is taking a “wait and see” attitude, with hopes to be flying across the Tasman by October this year.

Angus Kidman is the editor-at-large and frequent flyer guru for comparison site Finder.

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World covid vaccine rankings show Australia falling to back of the queue

Scott Morrison’s pledge that Australians would be at “the front of the queue” for COVID-19 vaccines has been smashed by new world rankings that put us on a par with Botswana according to one measure and 76th out of 152 countries in another.

Israel has emerged as the clear winner in the race to vaccinate its citizens with more than half of its population already receiving at least one dose of vaccine, and more than a third having received both doses.

But Australia is languishing compared to other countries including those in our region such as Indonesia and Singapore.

According to Our World in Data figures Australia ranks second last in all the countries analysed and sits below Ecuador on a par with Botswana.

But the Morrison Government argues these figures are not up to date and the more respected analysis is the work of the Financial Times.

But rather than putting Australia at the “front of the queue” the FT figures put Australia at the 76th country in the queue of 152 countries where data was analysed on the vaccine rollout.

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According to the FT analysis of the COVID-19 vaccine rollout the top 20 nations at the “front of the queue” are instead Israel, the United Arab Emirates, Chile, Bhutan, UK, Bahrain, Maldives, Malta, Serbia, Hungary, Puerto Rico, Qatar, Uruguay, Singapore, Estonia, Lithuania, Iceland, Morocco, Austria and Barbados.

On the FT ranking Australia comes in at 76th out of a ranking of 152 countries across the globe. Australia has vaccinated 4.5 people for every 100 citizens, compared to Rwanda, for example, that has vaccinated 2.8 people and Israel that has given 100 per cent of the population at least the first jab.

Australia ranks in a group of countries including Bangladesh, Bolivia and the Palestinian Territories. However, New Zealand’s rollout is still substantially behind Australia in terms of doses administered for every 100 people.

Countries that rank better than Australia for the vaccine rollout in the FT ranking include Cambodia, India, Mauritius, Colombia, Nepal, Indonesia, Jordan, Guyana, São Tomé and Príncipe.

The shock rankings follow a warning from NSW Premier Gladys Berejiklian today that she feared Australia was getting left behind in the race to vaccinate.

“At the moment what we’re trying to ascertain is exactly how many doses we’re going to get,” she said.

“It has been lumpy, as I’ve said. Some weeks we get more than we anticipated, other weeks we get less. I know that some people don’t think there is a sense of urgency because we’re doing so well, but things can change very quickly and I don’t want to see our citizens left behind because the rest of the world starts trading with each other, starts travelling. I do have a sense of urgency about it.”

On Sunday, the Prime Minister announced he was dumping his target of getting the majority of Australians vaccinated by the end of the year due to “uncertainties” surrounding vaccine imports and medical advice.

The PM will no longer commit to a timetable on when most Australians are vaccinated, a necessary step to reopen international borders and relax hotel quarantine requirements.

“The Government has also not set, nor has any plans to set any new targets for completing first doses,” he said.

“While we would like to see these doses completed before the end of the year, it is not possible to set such targets given the many uncertainties involved. We will just get on with the job of working together to produce, distribute and administer the vaccines as safely and efficiently as possible. These daily data reports will enable Australians to be kept informed of the progress.

“You will also be able to see how we are comparing to other countries, at the same stage of their roll out. The latest data shows that Australia’s vaccination program is advancing consistent with comparable countries such as Germany, and ahead of Canada, Sweden, France, NZ, South Korea and Japan at the same stage of their rollouts.

“At the end of this past week, it’s also important to note that more than 142,000 doses have been administered to our aged care residents, in more than 1,000 facilities, with over 46,000 of these now being second doses in over 500 facilities.”

The Morrison Government’s vaccine rollout has been hit by the revised medical advice over the AstraZeneca vaccine that it is not the preferred option for under 50s.

This decision was made because younger Australians are less likely to die from COVID if they contract it making the rare risk of a blood clot from the vaccine a higher risk from COVID, according to some experts.

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