Changes to the vaccine rollout: What are the immediate impacts for GPs?

Anastasia Tsirtsakis

9/04/2021 3:37:36 PM

Effects of Australia’s pivot from AstraZeneca to Pfizer for people under 50 are being felt as practices work to ease patient concerns. 

Vaccine consent form
GPs believe the recommended change from AstraZeneca to Pfizer will likely affect the patient consent process. (Image: AAP)

The ‘recalibration’ of Australia’s vaccine rollout – with health authorities recommending people under 50 receive the Pfizer vaccine rather than AstraZeneca amid concerns of a link to blood clots – is coming with immediate costs.
The change has been dubbed ‘a major setback’ for the country’s move to post-COVID normality and has raised concerns over a potential for increased vaccine hesitancy and heavier workload for GPs.
RACGP President Dr Karen Price told newsGP that general practices are already feeling the negative effects.
‘I’ve seen numerous clinics having to ring up reams and reams of patients who were arriving today [Friday] or next week for their AstraZeneca vaccine, who are under 50, for their first dose,’ she said.
‘That’s an enormous task for general practice. It’s not just simply a call that’s two minutes; there’s often a conversation that goes on with that.
'It’s what we do, it’s how we look after our communities, but it needs to be recognised that this is complex and expert work from general practice.’
GP Dr Mukesh Haikerwal’s practice in Melbourne’s west is among the those being inundated with calls. He says the announcement has added significant pressure.  
‘The switchboard is now starting to fill up. The calls will continue, and that is legitimate,’ he told The Guardian.
‘But who is paying for that?
‘Ultimately, we have to run our general business and people who need to be seen for other health issues aren’t getting through on the phone.
‘So it’s causing another roadblock in getting normal business happening while having an unhelpful conversation about “do I or don’t I get the vaccine?”’
The Australian Technical Advisory Group on Immunisation (ATAGI) has assured that it is safe for people under 50 who have already received their first dose of the AstraZeneca vaccine, who did not experience any serious side effects, to receive their second dose.
Dr Price does not anticipate the changes to significantly impact the currently underway phase 1b of the rollout, but she says GPs will likely face questions from healthcare workers and people with chronic medical conditions under 50.
‘That’s really going to be challenging because there’ll be some of those people who may have received their first dose, and we need to go through a very careful process of reassuring them because a lot of them will be feeling anxiety over this announcement,’ she said.
While the clinical guidance remains unchanged for people aged 50 and over, Dr Price says it is inevitable that GPs will need to address concerns from older cohorts, many of whom may have already been uncertain about the vaccine.
‘I would imagine there is going to be a lot more need to have a lot longer consultations with these people, going through a risk–benefit analysis and what it means,’ she said.
That has certainly been the case for Melbourne GP Dr Nathan Pinskier. He says his clinic is also facing increased calls and the announcement would no doubt impact on their consent processes.
‘We think this will obviously cause a degree of confusion for a week or so,’ Dr Pinskier said.
‘But hopefully we can get on top of that.’
Dr Price said while the Government is clearly ‘acting on the science’, she fears the impact of the ‘constant shifting’ of goal posts for GPs.
‘This is exhausting,’ she said.
‘And I am concerned about the pandemic fatigue, of course in our community, but particularly in our healthcare workforce. I am really worried.
‘But we’ve just got to remember … this is responding to science, this is responding to data, this is keeping people safe. That’s how we got to a good place and we’re going to continue to get to that good place.
‘Maybe it’s going to take a bit longer, but for the benefit of safety that’s what we need to do.’

Dr Karen Price says GPs will likely need to have longer consultations with patients to address any concerns over the AstraZeneca vaccine.

Professor Allen Cheng, a member of ATAGI, has stressed that the advice for under-50s is not a directive, but an opportunity to give people a choice.
‘We also carefully used the word “prefer” [Pfizer over AstraZeneca] in younger people. We respect patient autonomy, that people have a choice about the vaccines and treatments they get,’ he said.
‘If a younger person said that they were happy to take a one in 200,000 risk of clotting for the benefit of getting protected from COVID earlier, then as long as this was an informed decision, we should respect that choice.’
Professor Ross Gordon, a member of the World Health Organization’s Technical Advisory Board on Behavioural Insights and Sciences for Health, says to avoid a rise in vaccine hesitancy effective communication from Government is key – something he believes has been ‘lacking’ so far in Australia.
‘Those in charge of the strategy should communicate clearly with the public regarding when they might get the vaccine, where, how, which type of vaccine they will receive and any risks involved,’ he said.
‘It will be important that the promises made to the public from the communication of this information are met.
‘This will necessitate swift negotiation and procurement of other approved vaccines for those aged under 50, better planning and coordination of vaccine rollout, improved infrastructure, and effective communications with stakeholders; [for example] GPs, pharmacies, hospitals, clinics, and the public.’
Epidemiologist Professor Mary-Louise McLaws, on the other hand, thinks the announcement has the potential to improve uptake in the longer term, but agrees clear communication about side effects, albeit rare, is important.
‘I think people will feel a little more confident [and] cared for by the Government because the Government’s done this U-turn,’ she told newsGP.
‘Pfizer, Moderna and AstraZeneca all have issues with thrombocytopenia – so it’s not like they’re risk-free – but the average person in the community hasn’t been able to get that around their head.
‘They still think that Pfizer, because it has such high efficacy, doesn’t have any adverse events, but it does. It’s just that for one reason or another, it would appear as if there’s better marketing around that.’
Prime Minister Scott Morrison announced on Friday the Government secured an additional 20 million doses of the Pfizer vaccine, bringing Australia’s total to 40 million, with the new doses expected to be available in the final quarter of 2021.
‘We will obviously be doing everything we can to seek to move that forward where we can, but that is very welcome news,’ the Prime Minister said.
Novavax is another promising candidate, with 51 million doses secured pending data from ongoing phase 3 clinical trials and approval from the Therapeutic Goods Administration.
But Professor McLaws says looking at other alternatives, such as Moderna, should not be ruled out.
‘We always need another backup option because I think what we’ve learned about the slow rollout at the moment with AstraZeneca – and we’re supposed to be able to produce it onshore – is that you can’t rely on supply,’ she said.
‘That was an obvious worst case.’
General practice had only had a role in the delivery of AstraZeneca thus far in the rollout, but Dr Price says it is likely GPs in at least ‘some practices’ will administer doses of Pfizer.
‘We’ve seen reports of GPs getting special fridges and certainly the GP respiratory clinics may have a capacity,’ she said.
‘There may be a capacity in this instance … for Government to supply some of the infrastructure, just so that we can get people vaccinated.’
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Dr Nicholas John Brodie Page   10/04/2021 6:51:35 AM

I have heard from a patient in his 40s who is a scientifically literate corporate high flier who says the vaccine risk is very low and can he have it anyway if he signs the consent form detailing the risk.

Dr Ian   10/04/2021 9:13:24 AM

If there could be a way to predict the platlet drop this would be good .
A full blood 4 and 10 days after the vaccine is a way and would be very expensive but would create jobs and patients have to be told of the option as part of informed consent .
Then treatment with cortisone and IV immunoglobulin could save their lives .
Other illness could be early diagnosed which have been ignored over the year but the decisionsRe over and under treatment
could be overwhelming .
For health care workers under sixty at high risk of exposure and with no other vaccine available example novovax mRNA or monoclonal
antibody mixtures it could be a strong recommendation as the rate of thrombosis could be 0ne in One Hundred Thousand .
Europe ought adopt this .
Also aspirating before injecting is mandated in Denmark as anatomical variation as regards blood vessels in the Deltoid is very likely .

Dr Peter James Strickland   10/04/2021 7:20:59 PM

I am somewhat concerned about the way some vaccinators are actually injecting this Covid vaccine. It seems to be some very poor techniques with little actual control over the needle or syringe on injecting, and the vaccine itself will be ending up in multiple places in the upper arm from close to the periosteum of the humerus, muscle, fat, and possible blood vessels due to movement at the time of injecting. On TV I have seen nurses etc aspirating the vaccine from then bottle with a 21G needle, and touching the needle with their fingers in the process of entering and leaving the bottle!
There has to be a solution to preventing central venous thrombosis in anyone. ---where are the haematologists advising here? Is it 50-75mg aspirin in those not allergic to it for a few days post-injection, or some other preventative mechanism? The press have frightened people now, and that is the largest problem that has arisen for an extremely rare side-effect.

Dr Kate   12/04/2021 10:03:42 AM

So, by definition, the vast majority of people under 50 wanting to receive the Covid vaccination at present (ie 1b category) are people with underlying health conditions which place them at significantly higher risk of death or serious illness should they contract this disease (apart from GPs and other healthcare and emergency services workers who were in 1a like me but are still unable to access the Pfizer vaccine.... ). Surely the risk-benefit ratio would STILL fall in favour of having the A-Z vaccine in this group, even though at present the overall risk of contracting Covid in this country is still blessedly low (but we all know how quickly that could change). Why is this not the advice?

Dr Emad Mikhael Hanna   16/04/2021 8:40:11 AM

Why do not we get Sputnic V vaccine which has the best safety and effectiveness profiles as published in the NEJM and the Lancet, and it is kept in a normal vaccine fridge?