No plans for fourth COVID-19 vaccine dose for GPs

The eligibility for a fourth ‘winter’ dose of COVID-19 vaccine was expanded this week to include a broader range of people more vulnerable to severe disease.
 
The Australian Technical Advisory Group on Immunisation (ATAGI) recommended on Wednesday that people aged 16–64 with a wide range of comorbidities including cancer and diabetes, should have a fourth dose four months after a previous booster dose.
 
However, healthcare workers without extra risk factors were not included.
 
The most at-risk groups, including the over-65s, patients within residential aged care facilities, those with severe immunocompromise and Aboriginal and Torres Strait Islander people aged 50 and older, were recommended an extra dose in March. ATAGI confirmed at the time that would entail a fifth dose for severely immunocompromised patients, whose primary vaccination course comprises three vaccine doses. 
 
ATAGI said the decision not to include people according to employment, including healthcare workers, is based on an assessment of occupational risks as well as the protection offered by an initial booster.  
 
‘In particular, studies have shown that healthcare workers have a greater risk of acquiring SARS-CoV-2 infection in community settings than through exposure at work,’ the latest ATAGI statement reads.
 
‘People in these groups without comorbidity have been demonstrated to retain good protection against severe illness from SARS-CoV-2 several months out from their first booster dose.’
 
For vaccine efficacy, ATAGI referenced a UK Health Security Agency report suggesting vaccine effectiveness against hospitalisation remained at 76% at 105 days after a first booster, with 88% efficacy against death at 10 weeks.
 
The two studies cited in the ATAGI rationale on community spread are both US studies based on research conducted in 2020.
 
One piece of research looked at healthcare workers in Orange County in California in the early stages of the pandemic from 1 January, 2020 to 15 April, 2020.
 
Of 654 participants given serologic testing for COVID-19, 87 (13.3%) were seropositive, with 52 of those never having cared for a COVID-19 patient.
 
‘Prior to universal masking, [health-care professionals’] COVID-19 risk was dominated by workplace and community exposures while working in a dedicated COVID-19 unit was protective, suggesting that infection prevention protocols prevent patient-to-HCP transmission,’ the study concluded.
 
The other piece of research cited is an analysis of the impact of workplace and community exposure among healthcare workers at Montefiore Medical Center in New York from June to November 2020.
 
It found 29% of community exposures caused COVID-19 infection, compared to 2% for workplace exposure.
 
‘Even with deviations from standard personal protective equipment protocol, workplace exposures resulted in low frequencies of infection,’ the authors wrote.
 
However, GPs differed in their view on the ATAGI decision to exclude healthcare workers from a fourth winter dose.
 
Dr Lara Roeske is strongly in favour of broadening eligibility.
 
‘I absolutely would support a fourth dose for GPs and health workers for a number of reasons,’ she told newsGP.
 
‘Firstly, we are going to be the primary care providers to those that are eligible for the fourth dose by virtue of the fact that we will be in reasonably close contact with people.
 
‘It actually makes sense from that aspect, protecting those that are identified as being at risk and eligible for the fourth dose.’
 
Dr Roeske also believes that not enough has been done to protect GPs and advocates any possible measure that could help healthcare workers avoid infection.
 
‘With GPs being so critical in the response to COVID, I think it would be a really reasonable thing to do,’ she said.
 
‘Anything that we can do to protect an essential workforce [to] able to be at work, rather than, be sick at home … makes a lot of sense.’
 
For Perth-based GP Dr Sean Stevens, the current guidelines make sense given the minimal risk faced by GPs and healthcare workers without any extra risk factors.
 
‘I think healthcare workers are like any other members of society and the healthcare workers who are at risk do qualify … and should be front of the line for getting the fourth winter dose,’ he told newsGP.
 
‘The evidence is that a fourth dose in vulnerable populations will reduce the risk of severe illness and hospitalisation, but a fourth dose in healthy people doesn’t significantly reduce your risk of catching COVID.
 
‘If you’re a fit, healthy healthcare worker, then there’s probably not a lot of point.’
 
However, Dr Stevens said the unpredictable nature of the pandemic meant the advice should be subject to change.
 
‘That’s the thing with COVID – the goalposts keep shifting, the disease keeps changing, the evidence for effectiveness keeps changing,’ he said.
 
‘ATAGI is a very well respected, very sensitive body that includes GPs. I would hope that they would keep looking at new evidence as it arises.
 
‘If it is shown in the future that an extra dose is of benefit, I would hope that the GPs and other healthcare workers would be at the front of any subsequent rollout.’
 
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ATAGI COVID-19 vaccine winter dose