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AstraZeneca debate a ‘failure of pandemic management’


Jolyon Attwooll


30/06/2021 6:11:25 PM

RACGP President Dr Karen Price has stressed the decision around COVID vaccination should be shared by patients and GPs without outside interference.

Silhouette of hands holding AstraZeneca vial.
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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AstraZeneca COVID-19 indemnity vaccine rollout


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Dr James Courts   1/07/2021 7:09:42 AM

Look we either have ATAGI or we don't.

It doesn't help with the college fluffing around the edge trying not to upset their political masters.

I don't know about you but I have no time to have prolonged vaccine consults with the current workload especially where the advice changes hourly.

ATAGI/TGA/AMA/RACGP/State and Federal government please sort yourselves out.

I'm not going to go against my CHO and ATAGI with AZ under 40s, I have no confidence the College President and Scott Morrison will stand behind me with their pockets open.


Getafix   1/07/2021 7:17:00 AM

Kudos to Catherine Young for her integrity. Medical decisions should be based on evidence not mere political whim and impulse.


Dr Christopher Anthony Searle Gittoes   1/07/2021 7:55:46 AM

I am an Australian rural GP trying to determine the risk benefits of the Astra Zenica Covid 19 vaccination in patients <60years old
What we don't have is data on fatality rates (from TTS related blood clots) within age groups .
Australia Govt "Weighing up the potential benefits....... cites an overall fatality rate of 3% (of AZ vaccine associated TTS cases) and has given age related rates of AZ vaccine associated TTS cases however in order to determine benefit vs harm to the age groups listed, we need fatality rates within age groups.
UK data would be appreciated
Dr Chris Gittoes


Dr Ali Kolahdooz   1/07/2021 9:08:06 AM

What's the fuss about?!!
It's simple Maybe who are against AZ vaccine should take a Maths course again.
People around the world are dying of covid infection while not having access to even the Chinese or Russian vaccines and now here we are talking against AZ vaccine. What is the risk of every single person being hit by a car or a fallen tree?
grrrrrrr


Dr Jacqueline Chapman   1/07/2021 9:41:51 AM

What we need to know is when will the 16-40 year olds get access to Pfizer. If September the AZ hardly offers any benefit, even with a shortened 8 week between two doses, as it’s been mooted that one dose gives little benefit against delta variant. If not until December then it becomes much more relevant.
Secondly the young are not weighing up risk of vaccine versus risk of dying from Covid even if Dr Young is. They are weighing it up against a desperate need to get on with their lives where much bigger risks are taken every day. Some young folk are going to be happy to have AZ so they can go and climb Everest or bungee jump. The medical fraternity should not mistake our fear of risks with theirs. Good and proper discussion re the risk benefit analysis leading to satisfaction by GP that they understand fully the information. The Feds need to be upfront however
WHAT IS THE TIME FRAME FOR THIS AGE GROUP?


Dr Kodikkakathu Saratchandran   1/07/2021 10:35:43 AM

Pfizer and Moderna vaccines have their share of side effects that no one is discussing currently while becoming so concerned about and now deciding to stop the use of Astra Zeneca vaccine, the only locally manufactured vaccine, by October! The logic of it is plainly unclear!!


Dr Kylie Fardell   1/07/2021 11:45:12 AM

This doesn't seem as confusing as commentators are trying to make it, and risk benefit analysis is complex; we can't simplify a message so much that it is inaccurate. The AZ vaccine is approved for use by the TGA in those over 18. We now have sufficient supplies so that there are no logistic restrictions to people of any age accessing it should they choose to. Pfizer is preferred, but we can't guarantee whether or not there will be a major outbreak before it is available. The problem with waiting until there is an outbreak here to publicly announce that the risk benefit ratio favours vaccinating young people with AZ is that it is then too late, and people may already have been exposed. Ultimately, we're here to help people make an informed decision depending on their priorities.


Dr Peter James Strickland   1/07/2021 11:48:35 AM

The horse has bolted here! People are now absolutely scared of AZ caused by the press and differing advice by States, Commonwealth and innumerable experts. No-one wants to get the rare TTS. The 12 week period between AZ doses has been a problem and its lower efficacy on 1st dose (72%). Pfizer and other mRNA vaccines are better on the 1st dose (> 90% efficacy), and with only 3-4 weeks between doses makes it pragmatic for everyone, but it has not been available enough within Australia. due to supply failures from overseas. The respectoscope tells us we should be manufacturing mRNA vaccines NOW here in Australia, and everyone from young to old to get those vaccines NOW, and without these age group restriction declarations--problems solved, isn't it?


Dr Meng Sun Soo   1/07/2021 5:05:04 PM

The problem lies in the insufficient supply of the Pfizer vaccine. If we have enough Pfizer vaccine, all these issues are totally irrelevant. In my opinion the Australian Government should made a strenuous effort to Pfizer and ask them to send to us its vaccine as a matter of urgency.


Dr Dai-Bang Van Nguyen   1/07/2021 8:25:23 PM

Because of safety concerns:
Denmark stopped giving AZ COVID19 Vax to their citizens of any age about a month or so ago!
Spain stopped giving AZ COVID19 Vax to their citizens under the age of 60 year old about 2 months ago!
Dr J Courts , Dr J Chapman and my admirable Qld CHO, Dr Young, resonates with me!
I’ll not exploit the invincible mentality (psychology) of young people to sign them up to something that I believe is potentially deadly from HTTS! I’ve seen/known people with HTTS complications after AZ COVID19 Vax, have any of you commenting about the need for AZ COVID19 Vax for the under 60 in Australia in the current situation seen the complications???
I only listen to the Advice from ATAGI and the Qld CHO, Dr Young because the safety of my patients is paramount to me!


Dr Ratnakar Bhattacharyya   3/07/2021 2:57:11 PM

Current large scale study on Covid-19 vaccination adverse clot/bleedng reports indiacte effectiveness of both AstraZeneca and Pfizer Covid-19 vacciantion but Pfizer Covid-19 vaccaintion is better of these two and Pfizer Covid-19 vaccaition is not associated with Thrombototic thronbocytopenia syndrome(TTS) . Therefore Pfizer Covid -19 vaccaine should be available to all especilaly those with any comorbidity or at higher risk s, i.e.,coagulation abnormalities such as luous anticoagulant(LA) and raised APTT in absence of any other coagalation abnormalities i.e, D Dimer , with normal haeamtology , biochemistry , CRP no comorbidity including lupus erytheamtosus or any autoimmune inflammatory disease or any history past clotting , bleeding events such as gum bleding , epistaxis or bleeding from GIT or renal tarct. Pre and Post Covid -19 vaccaintion full coagulation studies on two identical groups of people(one gr.control) enable better understading vaccine realted adverse complications.