ATAGI advice eases COVID vaccination uncertainty ahead of rollout

It was clear during the Department of Health (DoH)’s general practice webinar on Wednesday that GPs have been left wanting for answers in the lead up to next week’s vaccine rollout.
 
A common query was the need for clarity over how practices are expected to manage the preparation and administration of the Oxford University/AstraZeneca multidose vials.
 
Among them, was Chair of RACGP NSW&ACT, GP and practice owner, Associate Professor Charlotte Hespe.
 
‘Most people have drawn up systems to be able to draw up the vaccines before the start, so you had everything all ready to go,’ she told newsGP.
 
‘But the training says you have to use it immediately after it gets drawn up, which begs the question – what does “immediately” mean?’
 
According to the Australian Technical Advisory Group on Immunisation’s (ATAGI) latest guidance, where doses will not be administered immediately one after another, each dose should be withdrawn and then administered to a recipient before another dose is withdrawn from the vial.
 
However, practices will be able to pre-prepare syringes under tight parameters.
 
‘Where doses will be administered immediately one after another [eg in dedicated immunisation clinics, including within general practice], it is acceptable to withdraw multiple doses consecutively from one vial in the preparation area, with each filled syringe [with a capped administration needle] appropriately labelled and stored at the appropriate temperature and protected from light, before each dose is carried across to the administration area for use as soon as practical for each recipient,’ the guidance states.
 
‘In this setting, it is acceptable to pre-draw multiple doses from one vial and use within one hour if stored at room temperature, or within six hours if stored at 2–8°C.’
 
To ensure vaccine efficacy and safety, any doses that remain in the vial must be refrigerated between 2°C–8°C immediately after vaccine draw-up is completed. 
 
Associate Professor Charlotte Hespe has welcomed the clarification.
 
‘It’s much more specific, and it’s got much clearer accountability,’ she said.
 
‘This takes it back to what practices were planning on doing in the first place. So being able to draw them all up, label them, and have them ready to go. They’re out of the fridge for an hour, and if they’re in the fridge, it’s all day, basically.’
 
While practices are being encouraged to vaccinate all patients on-site, ATAGI has stated that exceptions can be made for home visits for particularly vulnerable patients who are unable to leave their homes.
 
‘However, this would require careful planning at the practice level and would be the exception, not the rule,’ ATAGI states.
 
During the webinar, Dr Steph Davis, GP and a representative of the DoH’s COVID‐19 Primary Care Response Group, said practices will have to pay particularly close attention to ensuring minimal wastage.
 
‘The last thing you want to do is puncture a vial for that particular home visit and then not be able to use the rest of it and have seven or nine doses wasted,’ she said.
 
‘So it’s just about thinking about all of the steps in that process before you’re actually scheduling that.’
 
According to ATAGI, where possible, the vial should be transported and doses drawn up at the site of administration. Otherwise, if appropriate storage and prompt delivery within an hour can be achieved, pre-drawn doses may be transported.
 
The number of allocated doses listed in each practice’s on-boarding will be the ongoing supply for the first 12 weeks of the vaccination program, with practices encouraged to plan bookings in advance for the three-month period.

However, practices are being strongly advised against ‘stockpiling’ vaccines and will be required to demonstrate they have used their weekly allocation before being able to place their next order.
 
Dr Davis said allocation of doses has been based on each practice’s self-assessed capacity and practice population, as well as the density of the local population eligible for phase 1b.
 
‘So if a practice has been allocated 400 [doses] and they have ordered 400, they are expected to use that allocation in a week,’ she said.
 
‘If you are not able to do so, or you want to reduce your allocation, please contact us [at the DoH] and contact the VOC [Vaccinations Operations Centre] so that we can make those changes – and some practices have.
 
‘If you go through your first week and you’re not able to go through that allocation, that’s okay. No one is required to go above what they’re able to provide. But then your allocation thereafter will need to be reduced to an allocation that you’re able to use.
 
‘We want to minimise the chances of vaccines being left in fridges and not being used in the week because we want to ensure that we maximise the number of people who are receiving the vaccine every week.’
 
To ensure practices can avoid wastage, and meet targets, Associate Professor Hespe said it will be crucial to have an effective booking system.
 
‘You don’t want to overbook people because that’s going to get people upset more than having some spare,’ she said.
 
‘There’s a couple of the booking systems that will let you take into account what didn’t get used up one day … and have a list of people that you can call in at the end of the session if you’ve got some spare doses.’
 
Despite the slow start to the rollout and issues with the national booking system, Federal Health Minister Greg Hunt has assured Australia is on target to have the majority of the population inoculated with at least one dose of the coronavirus vaccine by October. To help ease the second phase, ATAGI has recommended that practices encourage patients to book their second dose at the time they have their first.
 
But while Associate Professor Hespe says the guidance is a step in the right direction, the recent issues with the vaccination booking platform shows there is still a need for clear and timely communication.
 
‘GPs just want an assurance that they’re going to have the vaccines on site,’ she said.
 
‘And it’d be nice if we could have the feeling [that] government is being responsive when they get it wrong.
 
‘[They could have] announced that it’s a slow rollout, expect in the next four weeks that you will start to be contacted by your GPs or then start to look for where [vaccinations are being offered], rather than having said it’s rolling out on Monday.
 
‘They’re clearly saying to us, you are not rolling it out Monday – it’s a little trickle from Monday. Why couldn't they have said that to the community as well?’
 
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