How many people were ‘waiting for Novavax’?

Back in October, a lot of expectation was pinned to the approval of Novavax.
 
In a poll run that month on newsGP, 55% of respondents said they were fielding daily queries from patients who were ‘waiting for Novavax’.
 
Hopes were high its more traditional, protein-based formula would shift the remaining vaccine-hesitant population over the line where AstraZeneca, Pfizer and Moderna had not succeeded.
 
Even though it is only four months ago, a reminder of the context of the vaccine rollout at that stage is important. Only the ACT had a double vaccination rate higher than 90%. Queensland, South Australia and Western Australia were still in the mid-60s range.
 
By the time Novavax was finally added to Australia’s vaccine rollout earlier this month, the situation was very different. Every jurisdiction apart from the Northern Territory has a double-vaccination rate of more than 90%, as attention turns to the booster program and vaccinating younger children.
 
When announcing its approval by the Therapeutic Goods Administration (TGA) as part of a primary vaccination course for over-18s, TGA head Professor John Skerritt couched his hopes cautiously.
 
‘I don’t know whether it is 50,000 or 100,000 or a million or whatever individuals [who will come forward for vaccination], I don’t think anybody knows but there are some individuals, and this just gives them further choice,’ he said.
 
How is uptake going?
Department of Health (DoH) officials have said they are using a working estimate of reaching around 5–20% of approximately 900,000 people aged 18 and over who have not had a primary course.
 
By those numbers, the lower end of that scale would be around 45,000 people receiving Novavax in total, while the higher end would push towards 200,000.
 
The initial days of the rollout – likely to be the busiest – have seen around 15,500 vaccinated with Novavax. The figure was confirmed by Dr Lucas de Toca, who leads the Federal Government’s primary care response to the pandemic, in the latest COVID-19 update webinar.
 
The total so far is around a third of the lowest end of the working estimate, with Dr de Toca upbeat about the impact.
 
‘That’s 15,500 people who otherwise potentially would not have gotten a primary course, so it’s really positive and good to see,’ he said.
 
Earlier this week, Federal Health Minister Greg Hunt said the uptake was ‘well ahead of what we’d anticipated in this timeframe’.
 
As expected at this stage of the rollout, the dial on first doses has moved in tiny increments in the few days since Novavax became available – a decimal point here and there in states and territories where public statistics are still reflecting the change.
 
The key question will be on how the rate of Novavax vaccinations changes. One Sydney GP told newsGP many places reported ‘some interest in the first few days and then a quick drop off to nothing’.
 
In a statement to newsGP, the DoH emphasised the rollout for Novavax is in its very early stages, notwithstanding that some doses were made available a week before the official launch date.
 
For many general practices at the forefront of Australia’s COVID vaccine drive, the anticipated demand has not been high enough for them to become involved; in NSW, fewer than 20% of general practices participating in the wider COVID vaccine rollout are reported to have ordered Novavax.
 
The same pattern appears to be playing out elsewhere too.
 
‘We run high volume vaccine clinics, or they do not work financially, so we declined to participate,’ Melbourne GP Dr Todd Cameron told newsGP.
 
‘Trying to offer vaccines to unenthusiastic patients is not a great way to invest your time. Nothing I’ve heard from colleagues has caused me to doubt that.’
 
A newsGP poll last week also suggests that many general practice managers share the same view.
 
More than 70% of those responding either said their general practice would either not be participating in the rollout of Novavax or would wait to see how much demand there was.
 
The DoH said more than 3000 GPs and pharmacies have expressed an interest in administering Novavax, with 2646 vaccination sites placing orders for more than 443,000 doses of Novavax.
 
Even if those doses are all administered, that number is slightly lower than 1% of the total 51 million doses the Government has placed on order – raising the related issue of what plans are in place for the leftover stock.
 
Booster approval?
The other big remaining question for the fourth vaccine to be approved in Australia is whether it will add to the available options for the booster rollout. While Novavax arrived too late for most of the population as a primary dose, the possibility remains for it to be useful in this later phase.
 
GPs are reporting requests for Novavax as a booster and are having to explain to patients that it is only currently available as part of a primary vaccination course. 
 
On a related note, Dr de Toca advised in the webinar that Novavax would not currently be covered by the vaccine compensation program if used off-label as a booster.
 
‘The vaccine compensation program [only] covers vaccines that are administered consistent with the national COVID vaccine program, which includes TGA-approved vaccines that are administered in line with ATAGI advice,’ he said.
 
Professor Skerritt said this week the process for Novavax’s approval as a booster is ongoing.
 
‘We’re expecting to receive initial data from [Novavax] next week,’ he told reporters on Wednesday.
 
‘They expect to provide the final data during the month of March, and I can’t predict whether that’s middle or end.’
 
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COVID-19 Novavax vaccination vaccine rollout