Australia's leading public health experts are calling for a reset in Australia's approach to hotel quarantine as Commonwealth and state tensions rise over the latest breakout of COVID-19 into the community.
And there are expectations, with vaccination rates growing around the world, that Australia will - possibly with weeks - start a blanket policy of insisting on travellers being vaccinated before coming to Australia, at least two weeks before getting on the plane.
"It is not a silver bullet, but it will lower the risk by 90, maybe even 95 per cent," leading epidemiologist Professor Tony Blakely told The Canberra Times.
"Because it not only stops being getting infected, but even if they're unlucky enough to be infected and be vaccinated, they will be less likely to transmit it onto somebody because their infection will be less intense."
In the midst of a debilitating and "very regrettable" three-day lockdown in the Perth and Peel regions, the West Australian Premier Mark McGowan is calling for Commonwealth help with quarantine insisting it is a federal responsibility.
The WA quarantine hotels are full, according Mr McGowan, and while he has secured from the commonwealth a temporary reduction in the weekly cap on returned travellers, he has warned, "if the Commonwealth is unable to assist with proper quarantine facilities, I am reluctant to return to the full 1,025 per week cap."
"That weekly number of returning residents is not something that can continue long term, without proper Commonwealth quarantine facilities being used," Mr McGowan said.
It is the first outbreak for the state in a year, and the Premier wants the federal government to help establish alternative quarantine sites - what he termed long term, without proper Commonwealth quarantine facilities - to city hotels, saying CBD hotels are "not fit-for-purpose quarantine facilities".
But the federal government is pushing back. The Defence Minister Peter Dutton said on Sunday that the WA government has made a "mistake" by using the Mercure Hotel, the source of the latest COVID-19 outbreak.
"Nobody is being critical of him for that. He doesn't need to be defensive. He doesn't want to be the next (Victorian Premier) Dan Andrews where they had significant problems," Dutton told the ABC's Insiders program.
The Defence Minister is also not entertaining any move for a federal takeover of COVID-19 quarantine and says immigration detention centres and air bases are not a quarantine alternative with thousands of people needing to be accommodated in tented facilities.
The federal government has been involved in the Howard Springs quarantine facility in the Northern Territory, 25 kilometres from a major airport.
Public health experts say a reset is needed.
"We do need more Howard Springs type facilities, I don't know why we've got the standoff between the feds and state governments. We should just get on with it," Professor Blakely said.
"Yes, we've got a vaccine program rolling out, but it's going to hit more hiccups, it's going to be at least until early next year when quarantine won't be as necessary so we should just get on and put some cabins in the paddock somewhere."
University of New South Wales epidemiologist Mary-Louise McLaws has been on board for a while. And she says if it is not used for this pandemic, it will definitely be used for the next one.
"I've been pushing for a purpose-built centre to be built from last year. It's now 12 months have gone by. They've had a whole 12 months," Professor McLaws said.
"It needs to be purpose built. It needs to have an air shoot somewhere close by, needs to preferably not be multi-storeyed."
But keeping quarantine in hotels is not to be ruled out, according to La Trobe University epidemiologist Hassan Vally. He says it can work.
"You have got to do everything you can, within the hotel quarantine to make sure that you reduce the risk of transmission," he said.
"So Victoria certainly has learned lessons and played paid a lot of attention to the flow of air through hotels to try and mitigate the risk of transmission within the hotel."
"I think that's something that everyone should be looking at, you know, that's relatively easy first port of call in terms of some, some sort of action to reduce the threat."
Quarantine is a federal responsibility under the constitution, but in dealing with this COVID-19 pandemic, the states and territories agreed to they would manage hotel quarantine "given their primary responsibility in delivering health care".
The Victorian government is looking at an alternative, possibly hybrid hotel-outdoor, model of quarantine and has sighted ten possible facilities in the state and has narrowed it down to one site. An announcement is due to be made soon.
The ACT government pulled out of hotel quarantine last week for cost reasons. It regards home based quarantine for returned diplomats as working very well for the territory.
Last week, the Australian National University offered space at its campus to quarantine returned Australian travellers, but it is not certain how such as scheme would adhere to the nation's hotel quarantine requirements.
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