Urgent calls for clarity over responsibility for COVID vaccine aftercare in aged care

Doug Hendrie

24/02/2021 6:22:58 PM

GPs say there are unanswered questions regarding who has oversight of any potential long term side effects related to the Pfizer/BioNTech vaccine.

Container of six Pfizer COVID vaccine vials.
GPs have called for clear guidance regarding their expected responsibilities during phase 1a of the COVID vaccine rollout. (Image: Castle Hill Medical Centre)

GPs are seeking urgent clarification and communication over their role in the event of any adverse events after a COVID vaccine is given to their aged care patients.
The calls come after two aged care residents in Queensland were mistakenly given higher doses of the vaccine. While the mistake has not led to any adverse reactions, the doctor responsible did not complete the mandatory training and has been stood down.
Vaccination programs in some residential aged care facilities (RACFs) have already begun, with the bulk expected to be done by private contractors including Aspen Medical and Healthcare Australia.
RACF patients form part of the priority group that will be given the Pfizer/BioNTech vaccine, but GPs believe they may be ‘dragged into it unwittingly’ if there are any adverse events that emerge later in their aged care patients. As a result, they have called for clear guidance regarding responsibility or expectations associated with phase 1a of the rollout.
RACGP NSW&ACT Faculty Chair Associate Professor Charlotte Hespe told newsGP that despite most GPs not being formally involved in phase 1a, they could well still be called upon.
‘In all their planning, the Department of Health hasn’t sent information to GPs to say, “Okay, we are organising a third party to vaccinate your patients. We need you to understand what that looks like and what your role is”,’ she said.
‘Surely the [rollout] could have been delayed a week to make sure everyone was very clear on roles and making sure everyone was informed as they go forward.’
Dr Hespe said GPs are being expected to play a role while not necessarily knowing what their responsibilities are.
‘It’s implicit that GPs are the ones who are going to do this. But we might not even know our patients are being done today,’ she said.
‘What happens tonight if half the residents in an aged care facility get side effects overnight?’
Dr Sachin Patel is the founder of the Aged Care GP service, which cares for patients in around 100 Melbourne facilities.
He told newsGP the exclusion of GPs from the process means it is ‘as if we don’t exist’. He and his team are bracing for calls from their regular facilities after the vaccination teams from Aspen Medical come through.
‘In Victoria, Aspen are charged with administering the vaccine and the 15 minutes afterwards, and RACFs are meant to be responsible for everything else. We’ve been left completely in the dark,’ he said. ‘Are we really expecting GPs to magically be available to sort it out?
‘The reality is, RACFs and GPs work well together normally. But now we’re in a crazy situation where RACFs are asking for help, and GPs have to say, “Well, we’ve been told not to do it”.  
‘We’re usually the ones to communicate with the patient and the family, from the starting point all the way through.’
Dr Patel said the incident in Queensland, in which a doctor was stood down after mistakenly giving two aged care residents a significantly higher dose of vaccine, is a warning sign.
‘That incident makes me worry about the governance if this is happening so early,’ he said.
‘We need to look at where the system fell down. Standing the doctor down is hanging them out to dry; yes, they made a mistake, but here’s a colleague who put up their hand to go help vaccinate.
‘Where was the support, the training, the discussion?’

RACGP NSW&ACT Faculty Chair Associate Professor Charlotte Hespe says GPs have been expected to play a part in phase 1a of the rollout despite not knowing what their responsibilities are.
In response to questions around oversight and planning, a Department of Health spokesperson told newsGP general practices and GPs are a ‘critical partner’ in achieving the COVID-19 vaccination rollout by providing comprehensive immunisation coverage for their local populations’.
‘The Department of Health, the vaccination provider, the local Primary Health Network and the facilities are working closely to plan for the rollout in aged care, including processes for managing consent,’ the spokesperson said.
‘As with all other vaccines, valid consent is required before administering each COVID-19 vaccine dose.’
RACGP Vice President Dr Bruce Willett also told newsGP it has been made clear that the phase 1a rollout is a Commonwealth responsibility, and that regular GPs have been not been included.
But he said communication has been good in his area in Brisbane, with notifications arriving to give the date for aged care vaccinations.
Dr Willett said that while most adverse reactions should happen in the first 30 minutes after the jab, it is possible some side effects could occur later. He called on GPs to be very cautious regarding their management of patients who have recently had their COVID jabs, given the huge public interest in the new vaccines.
‘GPs are very likely to become involved in having to defend their decisions around clinical management post-vaccination,’ he said.
‘One thing you can be absolutely certain of is that some extremely elderly people will have serious medical issues occurring within a week or so, and that these issues would have happened anyway.’   
According to Australian Product Information supplied by the Therapeutic Goods Administration (TGA), common side effects of the Pfizer/BioNTech vaccine include injection-site pain, fever and headache.
Uncommon side effects include enlarged lymph nodes in 0.1–1% of vaccinations, and rare side effects include anaphylaxis, at an estimated rate of one in every 200,000 injections.
NSW Health has also made a detailed list of possible adverse reactions available on its website.
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A.Prof George Theodore Somers   25/02/2021 9:00:17 AM

A bit late, now that we seem to have accepted this roll-out as our responsibility. This Public Health initiative should always have been the responsibility of Government Health Services. GPs were right to offer to assist. Government has now made it seem like our responsibility not theirs. If only our leaders could have seen this coming.