From 40 calls to 261 in one morning: rollout issues continue

The move to reduce the dosage interval for AstraZeneca down from 12 to six weeks, comes as community transmission of the Delta variant continues to sweep through Greater Sydney, with the state recording 112 new cases on Monday.
 
NSW Chief Health Officer Dr Kerry Chant asked people in local government areas of concern in south-west Sydney to bring forward their second dose if possible.
 
‘If you have had the AstraZeneca vaccine within the last four weeks, we are asking that you ring your GP and they may be able to bring forward your booking to that six- to eight-week period,’ she said.
 
RACGP NSW&ACT Chair Associate Professor Charlotte Hespe said the new advice, which is in line with the Australian Technical Advisory Group on Immunisation’s (ATAGI) guidelines, makes sense given the current rate of transmission.
 
‘It’s been in the ATAGI guidelines all the way through, that anything after four weeks through to 12 weeks [is acceptable and] we can provide flexibility depending upon a patient’s circumstances,’ she told newsGP.
 
‘That’s where we as GPs are ideally positioned to be able to help people understand [the changing advice].
 
‘We’re very keen in the current circumstances to be doing everything that we can to prevent further spread and obviously illness for people with the Delta strain.’
 
But the change in advice has been challenging for some practices.
 
Sydney GP Dr Daniel Chanisheff was among the recipients of a text message from the RACGP, sent in conjunction with NSW Health, to inform GPs of the changes over the weekend. He told newsGP his practice’s reception was ‘slammed’ with calls following the weekend’s announcement, up from 40 calls a day to 261 on Monday morning alone.
 
He said the chaos is due in large part to the fact that the Commonwealth COVID vaccine booking platform had not been updated – an issue Dr Chanisheff says he flagged with HotDoc a fortnight ago.
 
‘I actually reached out to HotDoc saying this is going to be an issue – people already want to get their doses sooner, [and the Therapeutic Goods Administration] TGA and ATAGI allow it, but unless [they] make it possible for us to do it through HotDoc, we’re going to get slammed with phone calls,’ he said.
 
‘And [HotDoc] just said “No. Can’t do it, sorry, because ATAGI and TGA advice was for 12 weeks” – which wasn’t true; it says 4–12 weeks on their website.’
 
A HotDoc spokesperson told newsGP on Monday that the company is aware of the issue and has now introduced a workaround for practices.
 
‘Clinics can now toggle a setting in the HotDoc dashboard to allow them to let patients book AstraZeneca from six weeks,’ the spokesperson said.
 
While Dr Chanisheff is glad the issue has been rectified, he says it should have been addressed before NSW Health announced the recommendation to the general public.
 
Associate Professor Hespe said the new vaccines timeline will increase stress on already under pressure GPs, as they assess whether it is logistically possible to accommodate rescheduled appointments and additional bookings.
 
She said general practices in NSW need more access to AstraZeneca, and that greater efforts must be made to develop flexible delivery models in order to reach and vaccinate people in hotspots.
 
‘I am advocating, along with the AMA and with NSW Health, to actually try and get more GPs access to be able to roll out either the AstraZeneca themselves or in partnership with NSW,’ Associate Professor Hespe said.
 
‘It [could] be something like a mobile clinic to general practices that are not in a position to either want to or be able to do the AstraZeneca vaccine program.
 
‘It’s tricky, particularly some of the areas that we’re looking at that have got the highest load of infection at the moment – there’s an awful lot of solo GPs who are not accredited and they don’t have electronic records.
 
‘So, we need to be able to figure out how to use them to help people engage patients and consent them without it being difficult.’


Associate Professor Charlotte Hespe says the new AstraZeneca vaccine timeline will increase stress on already under pressure GPs.
 
While research has confirmed that the shorter interval between doses lowers efficacy of the vaccine, Chief Medical Officer Paul Kelly said it is now an ‘issue of risk versus benefit’.
 
‘In Sydney right now, we need to weigh up immediate protection versus longer-term protection so the immediate protection that would come from earlier dose would make sense,’ he said.
 
To help ramp up efforts, people aged over 40 will be able to receive AstraZeneca through NSW Health vaccination clinics and centres without having to visit their GP, and pharmacies across the state have been given the green light to do the same.
 
Teachers and aged care workers in south-west Sydney will also be prioritised, with a vaccine hub due to begin operating at Fairfield Showground on Friday.
 
However, anyone aged 18–39 wishing to get the AstraZeneca vaccine is still being encouraged to talk to their GP.
 
As a result, Associate Professor Hespe said she anticipates GPs will be conducting more risk–benefit assessments with patients under 40.
 
‘Realistically, we don’t have a huge amount of Pfizer, so I think … we’re going to be having more conversations with younger people,’ she said.
 
‘Particularly with the slightly emotional ad campaign that was launched yesterday … which is obviously targeted at younger people to go and get vaccinated – before we’ve actually got a younger person’s vaccination program up and running.
 
‘So, it does mean that we have to get people to understand their risks and make a choice for themselves. Do you get your first AstraZeneca now? Or do you wait for Pfizer, knowing that if you’ve got no other risk categories, you may well be having to wait until November to access that?’
 
Associate Professor Hespe acknowledged that GPs are exhausted, given the numerous changes to the rollout, but encouraged all doctors to remember that they are not alone.
 
‘I would encourage people to reach out and find out how your colleagues are going … because you can learn an awful lot from how everybody else is dealing with it,’ she said.
 
‘We’re certainly trying to make sure that PPE supplies are all accessed through the PHNs … and we’re trying to strongly advocate, again, for the telehealth [parameters] to be a little bit clearer for people.
 
‘NSW Health is also really keen to be able to assist anyone who is struggling, and so I would encourage anyone to make contact with me if that’s the case, so I can link them up.
 
‘Together, we can do this.’
 
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AstraZeneca COVID HotDoc vaccine rollout