Blood clot case under investigation following Pfizer vaccine

Anastasia Tsirtsakis

21/04/2021 4:46:18 PM

The news comes as Australia moves to establish local mRNA manufacturing capacity and experts call for current Pfizer supplies to be redirected to younger cohorts.

Doctor holding vial of Pfizer vaccine.
By vaccinating younger age groups with a higher efficacy vaccine now, Professor Mary McLaws argues that more vulnerable cohorts are protected by default. (Image: AAP)

The Therapeutic Goods Administration (TGA) and Queensland Health are investigating the case of a 40-year-old man who presented to hospital on Wednesday three days after receiving the Pfizer vaccine, but is not currently admitted.  
The policeman, who works in the state’s hotel quarantine system, has a history of clotting, having recently developed deep vein thrombosis after undergoing knee surgery.
‘It’s too early to say whether this incident is linked to the Pfizer vaccine,’ Queensland Deputy Premier Steven Miles said.
‘Our authorities will be looking into whether there is a link here ... and looking to see if it can help inform the vaccine rollout.’
To date, Australia has recorded three cases of thrombosis with thrombocytopenia syndrome (TTS) that have been linked to the AstraZeneca vaccine and led the Australian Technical Advisory Group on Immunisation (ATAGI) to change its guidance for people under 50, with a preference for Pfizer.
Leading epidemiologist Professor Mary–Louise McLaws has welcomed the Federal Government’s pivot, but says the move appears to be ‘highly precautious’ given the very low risk.
‘They’ll still have a problem with thrombocytopenia and thrombosis … because there still is a slight risk with Moderna and Pfizer,’ she told newsGP.
‘But [Pfizer is] faster to roll out, if you have the supply, and it’s got great efficacy.’
Recent research from Oxford University found that while recipients of AstraZeneca, Pfizer and Moderna have a risk of blood clots, the risk is up to 10 times higher from contracting COVID.
‘The COVID-19 risk is higher than seen with the current vaccines, even for those under 30; something that should be taken into account when considering the balances between risks and benefits for vaccination,’ co-lead author Professor Paul Harrison said.
Following ATAGI’s advice, the push for local manufacture of mRNA vaccines has gained momentum with the Victorian Government committing $50 million towards establishing a local facility.
‘It’s vital that we can develop and manufacture mRNA vaccines and treatments locally to ensure we have vaccine security here in Australia and across our region,’ Acting Victorian Premier James Merlino said.
While the mRNA vaccines currently in circulation are the first to be widely administered in humans, they are proving to be safe and highly effective, with a faster capacity to be adapted to new viral variants. 
The Federal Government has expressed its support to adapt current capacity to mRNA, but Department of Health Secretary Professor Brendan Murphy said local manufacture is ‘unlikely’ to assist with the primary vaccination program, given it could take up to 12 months to develop.
‘But we may need boosters in the future,’ he said. ‘If these are ongoing and necessary, these vaccines are of interest to the Government and we’ve been asked to provide options.’
But at present Australia is reliant on offshore supply.
So far Australia has received less than two million of the 40 million Pfizer doses it has contracted, with the majority expected to arrive in the final quarter of 2021.
Along with aged care, disability care residents are among those eligible to receive Pfizer under phase 1a, but fewer than 7% have received a dose so far – about 1500 out of 25,000 – with thousands now turning to GPs for the AstraZeneca vaccine.
To help address the shortage of Pfizer, some experts are calling for current supplies to be redirected from aged care to people aged under 50, namely healthcare workers under phases 1a and 1b.
Adjunct Professor Bill Bowtell, who is a strategic health policy expert, is among them.
‘There should be no more Pfizer given to people in aged care,’ he said.
‘That should be directed to people under 50, healthcare workers and their families, and the AstraZeneca … should now go to all people over 50 as quickly as possible.’
Professor McLaws believes that should have been the strategy from the start.
Despite the fact the majority of Australia’s COVID deaths – 685 out of the 910 – were aged care residents, she believes the approach to focus on older people is ‘very compassionate’ but contrary to the reality of how transmission unfolds in the community.
‘Ask yourself, epidemiologically, who gets COVID in Australia? It’s the 20-to-39-year-olds, and when you add that up to 49-year-olds, they represented 53% of all cases,’ Professor McLaws told newsGP.
‘So if you ring fence everybody within that [younger] age group, who acquired half the number of infections, you will be protecting anybody older than 50.’
This is the concept she put forward to the COVAX facility last year.
‘I was suggesting that we focus on the frontline health workers, then the 953,000 health workers [including GPs],’ she said.
‘And then … the 20–39-year-olds. They are most mobile, they are heavily in the workforce, maybe underemployed and having to do multiple jobs. They’ve also got kids at school, and so they see a lot of other people.
‘I wouldn’t be giving [Pfizer] to anybody in aged care. That would be my fourth group because they’re covered by the group looking after them, [most of whom] are under 50 anyway and we don’t have circulating virus. Then give them … AstraZeneca.’
Along with Pfizer’s high efficacy rate of 91.3% (or 97%, according to Israeli data), Professor McLaws says the candidate could also help Australia achieve faster coverage given there is only a 21-day window between the first and second dose, compared to the 12-week wait recommended for AstraZeneca.
‘Israel’s had a good experience with Pfizer for its protectiveness after one dose, but that’s after at least 10 days,’ Professor McLaws said. ‘So you’ve got a much better buffer for the elderly.’
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Dr Wasan Haider Maghazaji   22/04/2021 7:01:21 AM

Totally agree Pfizer should be given to below 50 years of age & quickly.

Dr Elias Youssef Samaha   22/04/2021 7:35:21 AM

It’s difficult to distribute a limited resource fairly .

What keeps me up at night is the narrative once vaccinated people can travel without quarantine and pressure to open the border .

The virus mutated in two ways: 1. Changes shape of the spike protein - solution: an updated vaccine booster with the new blueprint. However ....

2. The virus is also acquiring stealth mutations to evade the immune system eg b1.351 strain where the spike protein is transiently bonded with a polysaccharide molecule, blocking the ability of the antibody to neutralize it or immune system to see it , similar to the HIV virus for which we have tried for 40 years to make a vaccine . The az vaccine is only 10% effective against this strain in a small study .

Rather than being tempted by a few tourism dollars, Let’s fight to keep the virus out of our beautiful country and keep Australia transmission free. The costs of letting variants on our health life and families life is far too great

Dr Graham James Lovell   22/04/2021 9:00:18 AM

I agree totally with Professor Mc Laws. Firstly when I see my over 90 year old RACF residents who probably won’t respond effectively to the vaccine similarly to their poorer response to the Influenza vaccine.Secondly as GP’s like myself who are seeing acute respiratory illnesses daily are wandering in unimmunised .... .
Also , we now have the ridiculous situation where new residents are arriving unimmunised and the Government has no plan in place to deal with the 40% of RACF resident turnover each year???

Dr Nicola   24/04/2021 5:52:30 AM

Agree with Dr Samaha. Thus current policy seems an 8 billlion dollar waste of resources other countries desperately need and we don’t need the side effects. Instead increase capacity and efficacy of quarantine away from population centres and keep this virus out until safe effective vaccines , perhaps nasal delivery to avoid humoral auto immune attack and better URTimmune defence to stop transmission . I think Mary and her push to vaccine here at present may be on the wrong track. Better , looking at the big picture over the next 4 years, perhaps to refocus on better quarantine . Hmm .

Dr Elysia Thornton-Benko   24/04/2021 7:33:02 AM

I agree with the suggested strategies in the article. It’s ironic that my mother with severe dementia and in her 80s has had Pfizer, whereas myself, a GP under 50, a mother of 3, has been provided no clear direction to date on how to receive Pfizer post the change in AstraZeneca recommendation. I had to be proactive to try to solve, which I have. Yet obviously there is limited supply at this stage. It’s far from optimal to be participating in vaccinating others, yet being unvaccinated oneself. GPs are “frontline” in that they see people who enter our practices from the community, often with acute illness.
At least Australia has been dynamic in responding to the issues, however under 50 year old GPs and health workers haven’t been prioritised adequately in my opinion, with communication regarding the solutions and related timing lacking. We are very fortunate so far in Australia, yet the next steps are crucial to get right!

Dr Peter JD Spafford   25/04/2021 8:17:34 PM

It is amazing that not only can the other countries do studies to ensure safety, manufacture and market a "safe and effective vaccine" in less than a year the virus was even found, but here in Australia "Health Secretary Professor Brendan Murphy said local manufacture is ‘unlikely’ to assist with the primary vaccination program, given it could take up to 12 months to develop," What is the problem?