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States and territories have been left scrambling to respond to government advice recommending against vaccinating anyone under 50 with the AstraZeneca Covid-19 vaccine, leaving tens of thousands of people in the lurch.
On Friday, New South Wales halted its AstraZeneca rollout entirely for several hours while patient consent forms with the latest information about the rare risk of severe clotting associated with the vaccine were added. The state’s rollout for people aged 50 and over has since resumed.
“As with all other vaccines, informed consent is required before administering Covid-19 vaccines, ensuring recipients make decisions based on an understanding of the risks and benefits,” a NSW health spokesman said. “AstraZeneca vaccinations for those aged 50 years and over will recommence later today.”
Meanwhile Western Australia has barred anyone under the age of 50 from getting the AstraZeneca vaccine. The chief health officer, Andrew Robertson, said effective from Friday: “People under 50 who are booked in to receive their AstraZeneca vaccine will have their appointments cancelled.”
People in the 1a and 1b vaccination program cohorts – including health workers – who are under 50 and have already received their first AstraZeneca vaccine, should “not be alarmed” and proceed to get their second jab, he said. “You should not cancel your second vaccination booking,” he said.
The Tasmanian government put an immediate hold on any first dose AstraZeneca vaccinations for people aged under 50, with the premier, Peter Gutwein, saying the state government was working through what the latest advice would mean for the ongoing rollout.
The advice to the federal government from the Australian Technical Advisory Group for Immunisation (Atagi) does not say all people under 50 should not receive the vaccine, but rather says the alternative Pfizer vaccine is “preferred”. The difficulty is Australia has low supply of the Pfizer vaccine, and GPs can not readily offer it to everyone as an alternative.
The advice says the vaccine can still be used in adults aged under 50 years “where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits”. People under 50 who have had their first AstraZeneca dose without any serious adverse effects can be given the second dose, the advice says.
The advice means general practitioners and nurses will be largely left responsible for talking through the advice with their patients under 50 and helping them to decide what to do, with GPs already reporting being inundated with calls from confused patients. The federal government and state and territory health departments could not immediately tell Guardian Australia how many eligible under-50s were affected, but more than 40% of the Australian population is aged between 20 and 50.
Guardian Australia asked the federal department of health how many under-50s eligible for the vaccine under phase 1b would be affected by the change to the advice. A spokesman for the department did not answer the question, saying: “Work is under way as an urgent priority to outline how the vaccine rollout will be adjusted to take into account the Atagi advice, working with the states and territories.”
The department also did not answer whether, given the lack of Pfizer availability, the advice to eligible under-50s who no longer want the AstraZeneca vaccine would need to be that they delay their vaccination until alternatives become available in Australia.
The confusion led the prime minister, Scott Morrison, to clarify in a press conference on Friday that: “I want to stress again that the advice … is not a ban on the AstraZeneca vaccine, it is not a prohibition on the AstraZeneca vaccine, it recommends and notes that the risk of these side-effects are remote.
“They are very rare,” he said. “We are talking in the vicinity of five to six per million, which is a rather rare event. But it must be acknowledged.”
The president of the Royal Australasian College of General Practitioners, Dr Karen Price, said phones were “running hot” as doctors tried to respond to patients’ questions.
“GPs are really a bit exhausted, and this is a major change, yet again,” Price said. “But it does need to be said that we are responding to the scientific data, it’s how we got Australia into a good place in the first place. And we need to continue to do that. And this decision is about scientific data. And it’s about safety.
“I would imagine there’ll be a range of responses from patients, including those people who will be really highly anxious, while other people will be pragmatic. It’s too early to really say. As GPs, we were aware of having to adapt to those individual circumstances and this risk-benefit equation, we’re going to have to discuss those on a case-by-case basis for those under 50.
“Some of those will be healthcare workers. And some of those will be those who’ve got complex medical conditions. However, what gives me hope is that the rest of the under-50 demographic were not due to come on board to the rollout until the second part of the year. So by then I hope we will have more vaccines available and a lot more clarity about the rollout.”
In the meantime, many previously eligible patients are wondering when they will be vaccinated.
In Victoria, health providers were also cancelling appointments. Barwon Health paused first doses of the AstraZeneca vaccine to people under 50, and patients turning up to appointments at other clinics were being turned away.
The federal health minister, Greg Hunt, said the federal government had secured an additional 20m Pfizer vaccine doses, but the delivery was not until the fourth quarter of the year. Hunt said the government was trying to negotiate bringing this forward.
“For those who may be immuno-compromised or frontline workers who are under 50, then right now we are working with the states and territories and the medical authorities to revise that part of the program so as they have access to Pfizer,” he said. “That will take time.”
The Grattan Institute health economist, Stephen Duckett, said he was already hearing from people over the age of 50 who were now also fearful of the AstraZeneca vaccine because of the latest government advice. It would be essential for the government to communicate clearly in coming days about why the vaccine remained highly safe, he said.
“I’ve heard people over 70 even saying ‘I don’t think I’ll get the vaccine now’,” he said.
“The commonwealth needs to be making it clear that AstraZeneca is the right thing for people over 55, rather than the public only hearing ‘there’s problems with AstraZeneca’,” he said. “That means the government getting the GPs back on side after all the problems they’ve had. And figuring out, well what are you going to tell a person over 70?
“This is not going to be resolved overnight. This is going to be an issue that can only be resolved over the next couple of months.”
Source: The Guardian
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