General practice to follow state Pfizer criteria

It was just last week that Australians over 60 received a letter from Prime Minister Scott Morrison urging them not to wait for Pfizer, warning they would risk ending up at the back of the queue.
 
So it came as a surprise to GPs on Saturday, when the South Australian Government announced the eligibility criteria for Pfizer would expand to include everyone over the age of 12 as of Monday, after months of trying to encourage and reassure hesitant patients over 60 to have AstraZeneca.
 
While the news was first announced in relation to state vaccination clinics, an email to GPs from SA Health confirmed that the updated criteria also apply to general practice.
 
‘As per advice received from the Commonwealth, GP practices that have capacity and available stock may book patients based on state and territory eligibility criteria for vaccination,’ the email reads.
 
‘Priority access to vaccination should still be given as per age recommendations.’
 
South Australia and the Northern Territory are unlikely to remain the only jurisdictions offering expanded access to Pfizer vaccines, with West Australian Premier Mark McGowan also confirming the state is ‘not far away’ from providing people over 60 with a similar option.
 
newsGP contacted the Federal Department of Health to confirm whether similar arrangements would apply should other states also unilaterally expand Pfizer criteria, but did not receive a response prior to publication.
 
Dr Emily Kirkpatrick, Deputy Chair of RACGP SA&NT and Deputy Chief Public Health Officer at SA Health, said it is welcome news that GPs will now be able to give older patients a choice.
 
‘Looking at our data that we have in South Australia, we know there’s a large percentage of people who have still not … taken up the AstraZeneca vaccine,’ she told newsGP.
 
‘That’s very concerning for us from a health point of view when we know there is that incredible risk from the eastern states, and of course with the plans for reopening up we want as many people vaccinated as possible.
 
‘So we’re hoping to see a really big increase now in our over-60 vaccine uptake rate.’
 
Adelaide GP Dr Daniel Byrne has certainly witnessed this hesitancy firsthand.
 
He says while general practice has done ‘an incredible job’ with vaccinating those aged over 70, that the 60–69-year-olds remained a challenge.
 
‘The over 70s clearly went for AstraZeneca, no problem, and the under 60s went for Pfizer,’ Dr Byrne told newsGP.
 
‘We were just left with this 10-year cohort between 60 and 69 who felt a bit miffed because they saw that they were very close to that age, and they think Pfizer is better and safer.
 
‘We’ve even had patients in their 90s going “No way, I’m waiting for Pfizer” and that’s quite dangerous; they’re not anti-vax, they’re just anti-AstraZeneca.’
 
As of 11 September, 59.1% of South Australians have received at least one dose of COVID vaccine and 40.4% are fully vaccinated. Slightly more than 40% of 60–69-year-olds are fully vaccinated.
 
Adelaide GP Dr Alvin Chua said it makes sense for the expanded eligibility criteria to include general practice, as GPs ‘should and would know their [patients’] history better than anyone else’.
 
‘I’ve always said the best vaccine is the one you can get in your arm right here, right now. But this latest about turn helps free us in general practice from being the vaccine police,’ he told newsGP.
 
‘It will make our job easier, and free us and our staff from abusive patients.
 
‘Only thing is, there will still be those waiting for their second AstraZeneca vaccine who will demand Pfizer in spite of not having had side effects.’
 
While those aged over 60 can access Pfizer, anyone who has safely had one dose of AstraZeneca is required to get the same vaccine for their second dose in line with advice from the Australian Technical Advisory Group on Immunisation.
 
Dr Kirkpatrick acknowledged the ongoing supply issues throughout the rollout, and said the expanded criteria is thanks to the 4.5 million doses secured by the Federal Government in swap deals.
 
‘We’ve had advice from the Commonwealth around the increase in doses that GPs will be having over the next two weeks, and certainly there is an ability for GPs to reorder their allocated Pfizer supply,’ she said.
 
‘And we do anticipate that some practices will be offered more uptake if they have the ability and the workforce to vaccinate as well.’
 
Dr Byrne said his practice, which is due to come on board to deliver Pfizer from next week, has already been offered to increase their fortnightly delivery from 300 to 900 doses.
 
‘So that’s why we’ve got plenty of vaccine to do the over 60-year-olds,’ he said. ‘Plus they’ll be vaccinated in three weeks, which is very good; nice and quick.’
 
The move follows the Northern Territory Government’s decision on 9 September to expand the rollout of Pfizer to people over 60.
 
Dr Kirkpatrick said this was a ‘really important’ step in the territory vaccine rollout to get older people who are particularly vulnerable to COVID vaccinated as soon as possible. 
 
‘We know that the NT vaccination rates have plateaued, so this will be really important to try and get as many people vaccinated as possible,’ she said.
 
‘We’ve given people the opportunity; we know that AstraZeneca is an excellent vaccine. But for those people that we haven’t been able to explain the benefits of AstraZeneca vaccine to and who have been holding out and waiting for Pfizer, we want to make sure we do get them vaccinated given what we’re seeing in New South Wales.’
 
However, even though Dr Chua said the news is welcome, he believes the lack of consistency and confusion brought about by different eligibility criteria across states and territories indicates there is a need for ‘a national CDC [centre for disease control and prevention] to make decisions for all Australians, rather than states going ad hoc’.
 
‘If the governments, both state and federal, were serious about a national rollout they would forget the “them and us” attitude,’ he said.
 
‘Have mass immunisation centres in each council or local government area held in town halls or even sporting stadiums locally. Approach GPs in the area and pharmacists to send staff and have a coordinated, unified national approach to immunisation and get as many jabs in arms as possible.’
 
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