This is an excerpt of an article by Anastasia Tsirtsakis, first published on newsGP, the website of the Royal Australia College of General Practitioners (RACGP). Read the full article here.
The Federal Government’s ‘COVID Vaccination Allocations Horizons‘ document, released on Wednesday, has projected that most Australians who are eligible to receive AstraZeneca’s COVID vaccine will be vaccinated by October.
By that stage, the plan indicates that AstraZeneca will only be available for distribution ‘subject to request’.
“For all of those people and cohorts that AstraZeneca is preferred, we think they will have received their AstraZeneca, before the fourth quarter,” COVID-19 Taskforce Commander Lieutenant General JJ Frewen said.
But following recent changes to the vaccine rollout over rare clotting concerns for those aged 50-59, GP and practice owner Dr Nathan Pinskier believes the Government’s target is ‘ambitious’.
Where Melbourne’s recent COVID outbreak saw demand for the AstraZeneca vaccine skyrocket in his clinics, he says they now have an oversupply, and that up to 40% of their scheduled second dose vaccinations have been cancelled.
“We’ve had a lot of anecdotal evidence, certainly through our clinics and I’ve spoken with a lot of my colleagues, that there are a lot of people in that group who are just waiting and they’re saying ‘I will just wait until Pfizer comes along’,” Dr Pinskier told newsGP.
While he says that GPs and practice staff are doing their best on the frontline to encourage people to come in for their second dose, he feels their efforts are falling on deaf ears.
“It doesn’t matter that we say that you’re not eligible or that the preferred vaccine for people over the age of 60 is AstraZeneca,” Dr Pinskier said. “What people are saying is ‘I’ve had a friend of a friend or a cousin or brother or an aunty or an uncle or a father who says they have very strong views about this, it’s not safe. I’ll wait until they make Pfizer available’.’
Burnet Institute Epidemiologist Professor Mike Toole agrees that the target is ‘quite ambitious’ given the countless first-hand accounts from GPs of people in their 60s cancelling bookings.
But he says the clusters that keep emerging in Australia’s cities suggest it would be ‘unfortunate if people wait until the Spring to get vaccinated’.
“We know with the Delta variant that it is more infectious, and if you’ve only just had one dose, the vaccines don’t offer much protection,” Professor Toole told newsGP. “So waiting for an outbreak to get vaccinated is not a good plan.
“People should get vaccinated now, in anticipation of future outbreaks – and I’m pretty sure there will be because our hotel quarantine system’s not working.’
The plan indicates that by July and August (Horizon 1), up to 2.6 million AstraZeneca and 750,000 Pfizer doses will be distributed nationally to primary care and state vaccination hubs each week.
From September (Horizon 2), mRNA vaccines will dominate supply, with up to 1.2 million AstraZeneca, 1.3 million Pfizer and 125,000 Moderna doses to be distributed weekly. While from October to December (Horizon 3), up to 2.3 million Pfizer doses will be distributed, along with up to 614,000 Moderna doses that have been specifically allocated to primary care.
Professor Toole believes if Pfizer doses arrive on time, and eligibility is opened to over 60s, that all adults could be fully vaccinated, at best, by December.
“But will we get them? I think we just have to wait to see,’ he said. “So it’s based on a fair bit of wishful thinking.”
And while the vaccination coverage needed to reach herd immunity has been the subject of ongoing debate, Professor Toole says at the current rate, it is not a realistic goal for Australia in 2021. Instead, he says Australia should simply aim to reduce as many hospitalisations and deaths as possible.
“At the moment, I think we have to put aside herd immunity as a goal because we’re just so far from it; we’ve fully vaccinated less than 5% of the population,” he said.
“We know from Seychelles 70% is not enough, so I think it will be well over 80% coverage to achieve herd immunity. Some virologists of course don’t believe we’ll ever achieve herd immunity; that if you are unvaccinated then you are vulnerable to infection. But it will slow down transmission if 80% of the population is vaccinated.”
So what would be needed to help GPs, if not reach the Government’s target, at least get close to it?
Dr Pinskier says a step in the right direct would be better and more timely communication between health authorities and doctors – and many GPs agree.
In the Department of Health’s (DoH) latest COVID-19 webinar on Thursday, there was a sense of frustration from attendees, following the announcement of ATAGI’s changes last week.
“[It would] be real … nice if I didn’t have to find out latest info [sic] from patients that saw it on the news. How hard is it to send us an email of changes one hour before releasing it to the press[?],” one GP commented.
The sentiment was echoed by another: ‘Please we need support … Media announcements, timing [and] communication pathways must improve.’
Dr Pinskier happened to be in a staff meeting when the news was announced on Friday, but he says the general message did not get out to most practices until Monday.
“We all got confronted by something that maybe wasn’t totally unexpected, but certainly hadn’t been communicated to us first and that would help,” he said.
“I’m wondering whether we need some sort of direct healthcare communications channel other than just email – maybe an SMS alert. I don’t know what, but we need something that tells us straight away that something has changed, so we just stay ahead of the curve.”
Dr Pinskier says it is clear a combination of loss of confidence in the rollout and low health literacy is hampering the efforts of practice staff, and that a strong marketing campaign is urgently needed.
‘I’m not sure posters and signs in waiting rooms now are cutting it,’ he said. ‘It’s hard to stay on top of this.”
Professor Toole says much clearer communication is needed about the benefits of the vaccines versus the risks.
“The message is that both vaccines, including AstraZeneca, will prevent you from ending up in an ICU if you get infected, that’s very clear now from the UK,” he said.
“You may get infected and that could be a problem in terms of infecting others in your family, but you won’t get severe COVID.
“The efficacy of AstraZeneca … even if you’re infected with a variant, is really high. But you need the two doses. It’s a huge difference in the UK between the efficacy after one dose and after two doses.”
Some GPs expressed during the DOH’s webinar that their efforts are being undermined by the release of the vaccination plan, with leading media outlets speculating AstraZeneca will essentially be phased out by October.
However, the DoH’s First Assistant Secretary for the COVID-19 Primary Care Response Dr Lucas de Toca pushed back against the claims.
Despite Lieutenant Frewen’s projections, Dr de Toca said the document ‘does not represent our expectation of vaccines in arms’.
“It’s just this is our supply and when we plan to allocate,” he said.
“The reason why there appears to be a phasing out or a zeroing out of AstraZeneca post October is because … by that time, there will be significantly more doses of vaccines circulating in the system through the distribution than we’ve had over the last few months … to cover more than the eligible AstraZeneca population.”
One thing is for certain, Dr Pinskier anticipates it is going to be a challenging 12 weeks for primary care.
“I’ve heard different stories from extremes where some GPs have said “We’re not actually going to provide AstraZeneca anymore’ to ‘I’m going to be very cautious about who we choose to give it to’,” he said.
“The message that it’s a preferred vaccine for people over the age of 60 and for everyone that’s had their first dose needs to be communicated loudly and clearly to everybody.
“A lot of people still don’t understand that the relative risk of not being vaccinated is much higher than the risks of being vaccinated; certainly when you’re over 60, it’s in your favour to get vaccinated [with AstraZeneca]. So we need to push that message very strongly.”