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AstraZeneca debate a ‘failure of pandemic management’
RACGP President Dr Karen Price has stressed the decision around COVID vaccination should be shared by patients and GPs without outside interference.
GPs are in a ‘difficult position’ when it comes to in obtaining informed consent from patients aged under 60 year who request the AstraZeneca vaccine. (Image: AAP)
Following what she described as a ‘fraught’ 24 hours, RACGP President Dr Karen Price has told newsGP the confusion caused by this week’s announcement needs to be resolved quickly.
‘We now have a confused public,’ she said. ‘That’s a failure of pandemic management – and it needs to be rectified.
‘As GPs, we’re trying to rectify it patient-by-patient, but we need a national advertising campaign. We need to have these messages very clearly and very simply played out in a national way.
‘There are people who devote their entire life to pandemic communication as an academic discipline, and this is not it.
‘We’ve really got to be very careful with regards to messaging now.’
On Tuesday, conflicting viewpoints emerged with other organisations speaking out against the essence of the Federal Government message, which encouraged people under 40 interested in receiving an AstraZeneca vaccine to talk to their GP.
It comes at a time when the AstraZeneca vaccine is likely to be the only one currently available for that group, with Pfizer availability already strained due to a reliance on overseas supply and high demand among older age categories.
Dr Price reinforced that consulting GPs about vaccination options is always strongly encouraged and not a new development.
‘We have a supply issue with Pfizer, and we have got an outbreak and we’re lagging in our rollout,’ she said.
‘There’s been a situation where some people aged under 60 have said “I want to get the vaccine” and so if they’re fully informed and they want to proceed that way, then that’s a consideration.
‘It was always a consideration within the ATAGI [Australian Technical Advisory Group on Immunisation] advice, but it’s not necessarily a recommendation.
‘What’s happened is the argument about which vaccine has become black and white – good vaccine versus bad vaccine. But there is no medication on earth that’s all good and this devolving into black and white thinking has been very problematic.’
Asked if she would administer AstraZeneca vaccine to a patient aged under 40 herself, Dr Price said each vaccination would need to be carefully considered within an individual patient context and be part of a shared decision-making process.
‘It’s a case-by-case discussion, noting that the ATAGI recommendations are what they are and there is a risk–benefit assessment that needs to be gone through.
‘If I thought they were informed to a legal amount of informed consent, then yes I would consider it.’
Dr Price also said the details of the COVID vaccination indemnity referenced by Prime Minister Scott Morrison on Monday are still being worked through – and that she would stop short of calling it a ‘no-fault’ indemnity scheme.
‘We have been working very closely with other peak organisations and the medical defence organisations to get an indemnity scheme that is supportive of applying a compensation scheme or equivalent for patients that also supports doctors,’ she said.
‘Those details are yet to be worked out. It doesn’t appear to be a no-fault compensation because if the doctor is negligent, it still applies.’
The current ATAGI advice reads as follows: ‘COVID-19 Vaccine AstraZeneca can be used in adults under 60 years for whom COMIRNATY [Pfizer] is not available, [when] the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits.
Dr Sara Bird, Executive Manager of Professional Services at medical indemnity insurance company MDA National, told newsGP the ATAGI advice is based on the fact that ‘there is currently no or limited community transmission in most of Australia’.
However, she said it is a ‘challenging and confusing situation’ for GPs, staff and Australian patients.
‘GPs are unable to predict the community transmission of COVID-19, which will change the benefit and risk discussion, and it may also be difficult to ascertain if Pfizer is available to patients within their community,’ Dr Bird said.
‘This puts GPs in a very difficult position in obtaining informed consent with patients aged under 60 year who request the AstraZeneca vaccine.’
Dr Price says some ‘very challenging’ legal wording stills needs to be worked through with the indemnity.
‘It’s not insurmountable,’ she said. ‘The actual legal wording around insurance contracts is very precise, and that needs to be very clearly clarified. We welcome the indemnity, we just want to see the details.’
She also reiterated the importance of care revolving around needs of the patient for COVID-19 vaccinations just as for other treatments.
‘The patient is at the centre of our treatment and the COVID vaccination decision is one we should be making on the basis of patient care,’ she said.
‘It’s not a political decision, it’s not an insurance decision – it’s a medical decision.’
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