GPs with AstraZeneca stockpile turn attention to vaccinating over-50s

Last week National Cabinet agreed to fast-track Australia’s COVID-19 vaccine rollout, to allow people over the age of 50 to receive the AstraZeneca vaccine sooner.
 
Originally eligible under phase 2a of the program, the new roadmap will officially commence for state, territory and Commonwealth vaccination clinics on 3 May, and on 17 May for general practices.
 
However, the Department of Health (DoH) has said that practices that have supply can bring forward vaccinations for Australians 50 years and older, but that they ‘should advise their PHN’ first.
 
Melbourne GP and practice owner, Dr Nathan Pinskier, member of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), is set to start this weekend.
 
While five of his practices have been receiving 50–100 doses each week, his Bentleigh practice has been receiving 400 and a decline in interest from patients eligible under 1b has seen the clinic left with a stockpile of around 1000 vaccines.
 
‘This Saturday we’ll be doing people over the age of 50. We sent out 500 SMS’s yesterday and changed all the posters to advise people over the age of 50 they can get vaccinated,’ Dr Pinskier told newsGP.
 
‘We have stock and our aim is to try and move as much of that 400 we get each week, every week. Just keep it going, basically.
 
‘I’ve heard the same comments from some of my colleagues and the GP respiratory clinics that they’ve had big stockpiles. The demand hasn’t been there.’
 
Since Dr Pinksier first began vaccinating patients in phase 1b, he says vaccinations have steadily declined from 600 per week to 200–300, coinciding with reports of blood clots associated with AstraZeneca.
 
‘When the news first hit, we surveyed 30 patients. We called them up – all were essentially over 70 – and of the 30 none of them were interested in coming in and getting vaccinated,’ he said.
 
‘That was a really interesting eye opener.
 
‘I managed to convince three of them to come in and book, but the common response was “We’re not sure the vaccine is safe; we don’t see what the risk is at the moment, and we’d prefer to wait until the ‘safer’ Pfizer vaccine is available”. That was a fairly consistent response.’
 
Now he is getting a similar response from people aged over 50.
 
Of the 500 people Dr Pinskier’s practice has contacted so far, only 50 have expressed interest in receiving the vaccine, accompanied by the question ‘But which vaccine will I be receiving?’
 
Melbourne GP and member of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), Dr Mukesh Haikerwal, who runs a practice and respiratory clinic, has also seen a decline in bookings and is planning to expand to over 50s on Tuesday.
 
‘We were full, but we’re now half full,’ he told newsGP.
 
‘We’re increasing our supply of vaccination space because of the new setting, which I think is essential and vital and a great move. So hopefully that will see some more interest from Tuesday.’
 
So far Dr Haikerwal says he has received a positive response from over-50s. While he has welcomed the decision of National Cabinet to expand the eligibility criteria, he says it should have been done from the start.
 
‘It’s not worked; I just wish that they’d take that plan and throw it away,’ he said.
 
‘Get a decent proportion of the population vaccinated against COVID before we get our next slamming from infections. And this is the only way of doing it; remove the red tape, make it easy, get supplies into people’s fridges and get the shots into people’s arms.’
 
But while vaccination is opening up to more cohorts, concerns remain around supply.
 
Dr Maria Boulton, a Brisbane GP and REC–FHSR member, says her practice has just received the go-ahead to open up vaccinations to over-50s on Monday, but that their allocation of vaccines remains low.
 
‘We have filled our clinics and have used our allocated 50 doses per week, every week since we joined the rollout,’ she told newsGP.

‘[But] we could be doing 20 times that, [and so] we continue to request more doses. We have more than 15,000 patients on our books.’

Dr Pinksier says there is a 2–3 month wait at one of his clinics for older patients in phase 1b, and while some have been able to get vaccinated through his Bentleigh clinic, others have been left with no choice but to wait.
 
‘I don’t think that makes any sense, and we’ve pointed that out to the Commonwealth,’ he said.
 
‘We’ve got this unusual situation where we’ve got excess stock, but … we’ve been advised that we are not permitted to move the stock. I can take a vaccine out to an aged care facility or to a private home, but I can’t move a box of 10 or 20 vials between clinics.
 
‘So we’re forced to move the patients between clinics, which means that the information ends up on another database rather than their regular practice, which undermines the principle of continuity of care.
 
‘It’s just not reasonable that the Government is not reviewing the stock availability and making more available to practices who need it on a demand basis, the same way that influenza works. It’s not clear why this can’t be addressed quickly.’
 
Dr Haikerwal agrees, and says it is the whole supply chain that ‘is the problem’.
 
‘If we gear up … we can’t get any more vaccine until we hit a certain threshold. Then it takes two weeks for it to be delivered,’ he said.
 
‘So it’s going to be an interesting timing issue as to how we get the vaccine through the door.
 
‘The point is, we should be having our local supply coming live, and we should be having more general practices listed in the vaccination process, like we do with influenza. [Instead] we’ve gone and complicated this.’
 
But even with the expanded eligibility criteria, Dr Pinskier remains concerned about the decline in uptake, and says more needs to be done around communicating the risks versus benefit.
 
‘For some reason we’re not achieving the demand that we should – whether it’s apathy, lethargy, concern – I don’t know what it is. But I don’t think we’ve hit the right comms message,’ he said.
 
‘If you compare that with flu vax, it’s automatic – “I’m going to get my flu vax, I understand the risk”. We haven’t got that with COVID vaccination at the moment.
 
‘On the basis of what’s happening with the AstraZeneca vaccine, you probably wouldn’t take any medicine because of the potential side effects.’
 
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