GPs expected to take leading role in COVID vaccine rollout expansion

Prime Minister Scott Morrison has announced the inclusion of all children aged 12–15 in the national vaccine rollout, after the recommendation was issued by the Australian Technical Advisory Group on Immunisation (ATAGI) – a move backed by the RACGP.
 
‘Vaccination against COVID-19 is recommended for all individuals from 12 years of age, extending the current recommendation for those aged 16 years and older,’ ATAGI said in a statement.
 
‘A two-dose schedule using Comirnaty [Pfizer], the only vaccine currently registered for use in Australia in this age group, is recommended.’
 
Prime Minister Morrison said that bookings for children will officially open on 13 September with vaccinations commencing from 15 September to allow vaccinations for the 16–39 cohort to get underway.
                           
‘That is the next pressure on the system and so we will allow that to commence and then on 13 September, then people will be able to make those bookings,’ he said.
 
‘Principally I would see that happening, especially through the GP network, and that provides the opportunity for family vaccinations.’
 
The recommendation comes as an increasing number of children are testing positive to the Delta variant, with those aged 0–19 now accounting for 9453 of the total COVID cases confirmed in Australia – more than all cohorts aged 60 and over combined (7692).
 
RACGP President Dr Karen Price said the decision is a key step forward in the rollout.
 
‘This is not a virus that only infects and hospitalises older people. It affects children too and we must vaccinate as many people who are eligible as fast as we can,’ she said.
 
‘Just this week, we learned that authorities are increasingly concerned about the number of children being infected with COVID-19. Although they are less likely to suffer from serious effects, we have seen from international experience that when you have lots of COVID-19 cases the number of children in hospital rises significantly.’
 
According to ATAGI, adolescents appear to have infection rates similar to adults and approximately 4–7% experience severe outcomes.
 
‘Overall hospitalisation rates for COVID-19 in the adolescent age group are higher than for other diseases such as influenza,’ ATAGI said in a statement.
 
‘In the USA, COVID-19 hospitalisation rates in adolescents from October 2020 to April 2021 were 2.5–3 times higher than that for influenza-associated hospitalisation rates from three recent influenza seasons.’
 
Dr James Best, Chair of RACGP Specific Interests Child and Young People’s Health, welcomed the fact that there is sufficient safety data and vaccine availability to expand to children, and said group bookings are a pragmatic approach for uptake.
 
‘Now we’re talking about vaccinating people who cannot take themselves to the doctor; if you’ve got a 12-year-old then they need to be accompanied,’ he told newsGP.
 
‘So having that flexibility to be able to vaccinate parents and a young person at the same time will obviously be an enabler of the process. But different practices will have their own approaches.’
 
A Department of Health spokesperson told newsGP that it is working with HealthEngine ‘on potential amendments to the Commonwealth Booking Platform to enable bookings for groups or families’, but that practices will continue to manage their bookings as they see fit, based on vaccine availability, practice capacity, as well as local priority populations.
 
‘GPs and other medical professionals are remunerated on a per patient basis, based on the Medicare Benefits Schedule COVID-19 Vaccine Suitability Assessment Services,’ the spokesperson said.
 
‘GPs are encouraged to continue to prioritise vaccines to those most at risk, including aged and disability care workers and Aboriginal and Torres Strait Islander people, pregnant women and those with underlying medical conditions.’

RACGP President Dr Karen Price says while children appear to be less likely to develop severe COVID-19 that the experience unfolding abroad in countries with high infection rates is concerning.
 
The Therapeutic Goods Administration (TGA) expanded its provisional approval of Pfizer for 12–15-year-olds on 23 July, while its use has been recommended for at-risk children – including NDIS participants, Aboriginal and Torres Islanders and those in remote communities – from 9 August.
 
Results from an ongoing phase 3 trial for the Pfizer vaccine, involving more than 2000 participants aged 12–15, show efficacy against symptomatic infection is 100% seven days after the second dose.
 
Protection has also proved to be relatively high 11 days after the first dose, with three cases of COVID-19 recorded compared with 12 cases in the placebo group, equating to an efficacy rate of 75%.
 
In phase 2 and 3 clinical trials, local and systemic adverse events within seven days following vaccination were frequently reported but generally mild-to-moderate in severity, typically resolving within 1–2 days.
 
When it comes to myocarditis and pericarditis, the crude reporting rate in the USA Vaccine Adverse Events Reporting System (VAERS) data in males aged 12–17 was 10 cases per million for dose one and 67 cases per million for dose two, with the vast majority of cases mild.
 
But despite the promising results, Dr Best said GPs will need to be supported with appropriate materials to reassure parents about the benefits of vaccination.
 
‘GPs are talking to patients about vaccination [and] all of us are already aware of how challenging that has become. I think as we expand into younger age groups, the younger you go, the more emotional those conversations will become,’ he said.
 
‘People worry about their health, but people really, really worry about their children’s health. And so I think that this is yet again, another hurdle that we will have to get over in dealing with that anxiety.’
 
Dr Best said he has no doubt that GPs will have a vital role in addressing any concerns parents and carers may have.
 
‘The role of the GP is critical,’ he said. ‘What doesn’t tend to work in this situation is just throwing information out there.
 
‘If it comes out of the mouth of a trusted source like the GP that the patient has connected with and knows, that’s what works in regard to addressing vaccine hesitancy.’
 
Currently, Pfizer is the only vaccine for COVID-19 registered for children under 16 in Australia. The TGA is considering Moderna for 12–17-year-olds, with a decision expected by early September.
 
ATAGI anticipates that as well as preventing infections, hospitalisations and deaths, vaccination will help protect against other complications such as Paediatric Multisystem Inflammatory Syndrome Temporally (PIMS-TS) and long COVID-19.
 
Dr Price said that many people, including children, may be overwhelmed and confused by the evolving eligibility requirements. She said parents and carers should be encouraged to start talking with children about receiving the COVID vaccine.
 
‘It is important to carefully explain to children that this vaccine will help keep them safe and protect vulnerable people in their community,’ she said.
 
‘It may be helpful to mention that they have previously been given other vaccines for diseases such as polio and chickenpox.’
 
While Pfizer and Moderna are running clinical trials in the northern hemisphere for younger cohorts, a COVID-19 vaccine has yet to be approved for children under 12. In the meantime, Dr Price urged older Australians to consider this when weighing up whether to get vaccinated.
 
‘Please don’t just think about yourself. Think about those who don’t even have the option of being vaccinated and what your decision could mean for them,’ she said.
 
‘[Children aged under 12] are less likely to suffer severe effects, but the number is far from negligible. The Delta strain is far more infectious than earlier variants and striking populations who aren’t vaccinated, and that means our children.
 
‘Don’t forget that vaccination has always been about both the individual and the broader community.’
 
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