Government clarifies GPs’ position as states expand Pfizer eligibility

Older Australians have been asking GPs some variation of the question for months.
 
‘Can I get Pfizer instead of AstraZeneca?’
 
For many of these patients, it appears the answer will now be yes.
 
Western Australia and Queensland have become the latest states to offer people over the age of 60 a choice between the AstraZeneca and Pfizer vaccines.
 
It follows months of GPs turning away patients who were hesitant to receive AstraZeneca amid concerns over a rare adverse reaction – despite having no contraindications to the vaccine.
 
While Western Australia and Queensland have announced the decision to allow over-60s to access Pfizer in their state-run vaccination hubs, a Department of Health (DoH) spokesperson confirmed to newsGP that the new criteria will also apply to general practice, as is the case in South Australia and the Northern Territory.
 
‘If general practices have capacity and available stock, they can take additional bookings based on state and territory eligibility criteria,’ the spokesperson told newsGP. ‘And this has been communicated to primary care sites in the relevant jurisdictions.’
 
Dr Bruce Willett, RACGP Vice-President and Chair of RACGP Queensland, told newsGP expanding the eligibility criteria for Pfizer will likely speed up the rollout, particularly as states witness the threat of outbreaks in New South Wales and Victoria.
 
‘The reality is that we’ve probably close to saturated the AstraZeneca-willing [patients], so it is actually going to help get groups vaccinated more quickly,’ he said.
 
GPs were first alerted to the Federal Government’s move to allow general practice to mirror state and territory eligibility criteria in the DoH’s provider bulletin on 23 August, when 16–39-year-olds became eligible for Pfizer.
 
‘To simplify the transition of national eligibility to include those aged 16–39, practices that have capacity and available stock may book patients based on state and territory eligibility criteria,’ the bulletin reads.
 
However, DoH First Assistant Secretary Dr Lucas De Toca indicated that the policy change applied more broadly during an online COVID-19 response update for GPs on 2 September.
 
‘Primary care across the spectrum [is] allowed, if you have available appointments, available spots, and you’re still prioritising the high-risk groups … to follow expanded state- and territory-based eligibility,’ he said.
 
To date, more than 88.1% of over-60s have had their first dose of a COVID-19 vaccine.
 
It was in May that Federal Health Minister Greg Hunt indicated that as supplies of Pfizer and Moderna increase there would be enough mRNA vaccines ‘for every Australian’, which many took to mean older people could choose to wait.
 
The Federal Government later backtracked on the statement, and just last week sent letters to thousands of unvaccinated 60–69-year-olds encouraging uptake of AstraZeneca.
 
Within a matter of days of the letter being sent, the majority of jurisdictions, excluding New South Wales, Victoria and Tasmania, have made Pfizer available to over-60s.

Earlier this week, Victorian Premier Daniel Andrews ruled out the move for his state.
 
‘I’m not going to take the only vaccine available for 12-, 13-, 14- [and] 15-year-olds and give it to 60-year-olds, when 60-year-olds have got AstraZeneca they can access,’ he said.
 
But what appear to be recently updated Victorian eligibility guidelines for people over 60 tell a different story.
 
Beyond Australian Technical Advisory Group on Immunisation (ATAGI) contraindications for AstraZeneca, the guide for access to Pfizer includes people with conditions that place them at increased risk of severe COVID-19, including heart disease, diabetes, severe obesity and poorly controlled blood pressure.
 
This suggests a large portion of older people are in fact eligible for an mRNA vaccine.
 
Between 15–20% of Australians aged over 65 have diabetes, 20% of men and 12% of women aged 65–74 have heart disease, and two in five people aged 65–74 were classed as obese in 2017–18.
 
‘Victoria provides this vaccination pathway to ensure everyone can access the most appropriate vaccine for their health needs when deemed necessary by a specialist clinician or general practitioner,’ a Victorian Department of Health spokesperson told newsGP.
 
In comparison, NSW Health’s exemption list remains in line with the contraindications set out by ATAGI.
 
The spokesperson said the vaccination pathway is specific to Victoria and endorsed by its public health experts, and that it has been available for several months.
 
However, GPs were only informed of the expanded eligibility in a Victorian Department of Health special bulletin for COVID-19 vaccine providers on 12 September.
 
RACGP Victoria Chair Dr Anita Muñoz said while extensive efforts have been made across various channels to ensure GPs are across the changes, amongst ‘the massive flood of information, lots of people must have missed this information’.
 
She told newsGP the decision to have uniform eligibility criteria between state vaccination sites and general practice is important to help streamline patient messaging around the rollout.
 
‘There will definitely be no adverse consequences for a GP that follows their state criteria if they have the supply and the capacity to do so,’ Dr Muñoz said.
 
‘The next step will be to have all the states and GPs doing the same thing, and I think we’re working towards that.’
 
The main issue that remains now, according to Dr Muñoz, is supply.
 
‘We know that being able to increase the people that you’re offering [Pfizer] to is dependent on supply, and I think that the Federal Government are aware of that and they’re trying to solve that issue,’ she said. 
 
Dr Willett agrees that there are likely to be ‘some road bumps’ now that eligibility has expanded, including from those who have already received one dose of AstraZeneca now seeking Pfizer.
 
‘There’s still no TGA approval for mixing vaccines,’ he said. ‘So we’re going to be under increasing pressure from patients who’ve had one AstraZeneca who are going to want to have a follow-up Pfizer.
 
‘I personally wouldn’t do that because it’s not approved, but this is going to add to the pressure around that.’
 
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