New AstraZeneca guidance reinforces need for vaccine counselling MBS numbers

Anastasia Tsirtsakis

17/06/2021 4:58:19 PM

The decision to limit the use of AstraZeneca’s COVID vaccine to only people aged 60 and older will likely place more pressure on GPs dealing with vaccine-hesitant patients.

Doctor drawing up dose of AstraZeneca vaccine.
People who have had their first dose of AstraZeneca without any serious adverse events are still recommended to receive a second. (Image: AAP)

General practice is set to pivot once again, following the Australian Technical Advisory Group on Immunisation’s (ATAGI) recommendation to vaccinate all eligible people under 60 with Pfizer’s mRNA vaccine.
The new advice follows the recent death of a 52-year-old woman, who developed a severe case of thrombosis with thrombocytopenia syndrome (TTS) after receiving the AstraZeneca vaccine.
RACGP President Dr Karen Price said GPs are flexible and will be able to adapt to ATAGI’s guidelines, but that the decision only adds to the urgent need for MBS support for longer vaccine counselling consultations.
‘This is ATAGI responding to the data as it’s coming in, and so we are going along with that science,’ she told newsGP.
‘It doesn’t mean there’s a “good” vaccine and a “bad” vaccine, it just means there are vaccines appropriate to the circumstances. We still need to get vaccinated.
‘However, people are going to want to have these changes explained to them. They’re going to want to know whether or not they should get a second AstraZeneca dose … and you’re going to have those people over 70, who desperately need to be vaccinated, who are probably going to have continuing questions.
‘There might be people too, who want it and they have to wait, so that’s another conversation that we have to have.’
Australia’s Chief Medical Officer Professor Paul Kelly said ATAGI advice was made following a risk–benefit analysis of the vaccine in Australia’s current context, as well as what might happen in the coming months.
‘That’s a really important message,’ he said.
‘AstraZeneca remains a very effective vaccine. The benefit of AstraZeneca in the over 60s remains much higher than the risk of this particularly rare, but sometimes serious, syndrome.
‘People over 60 should still be rolling up to their GP or wherever they are getting their AstraZeneca vaccine, and getting that first dose.’
Those who have had their first dose of AstraZeneca without any serious adverse events are still recommended to receive a second dose of the vaccine, regardless of age; even though few second doses have been administered in Australia, as data from the UK suggests the risk of TTS is only around 1.5 per million.
As such, Professor Kelly encouraged people to ‘keep that booking’ for their second dose.
‘Go and talk to your GP about it if you’re concerned,’ he said.
‘But on the basis of information we have in Australia, we have not had a single case of this particular syndrome in a second dose.’
There were 12 new cases of TTS recorded in the most recent Therapeutic Goods Administration’s (TGA) weekly safety report, seven of whom are aged 50–59. The overall case fatality rate of TTS in Australia is 3%, with two deaths from 60 cases.
Dr Price said while general practice ‘is getting tired’, she has no doubt ‘we’ll step up again’.
‘As GPs we are highly adaptable community physicians, and I am just so proud to represent the hard, hard work that they’ve done under such difficult circumstances,’ she said.
‘And with everybody making demands on general practice, it’s been enormously amazing how general practices have still responded with professionalism and for the benefit of the community.
‘That should not go unrecognised.’
Federal Health Minister Greg Hunt said the Government acknowledges there will be logistical challenges given the reliance on overseas supply, but he remains optimistic.
‘In the first three months of the rollout from February to May, we received 3.4 million doses of Pfizer. This month we’re expected to receive 1.7 million and next month that will grow to 2.8 million doses,’ he said.
‘That’s what will allow us to expand the coverage. And then over the balance of the year, and I’ve had this reaffirmed by the country head of Pfizer today, we will receive the remaining 32-and-a-half million doses.
‘So that means that we remain on track to receive all of our Pfizer during the course of this year.’
However, Minister Hunt did go on to say that Australians, particularly those aged 50–59, will have to be patient until supply comes through.
During a press conference on Thursday, COVID-19 Taskforce Commander Lieutenant General John James Frewen said the updated advice will fasttrack the onboarding of general practice clinics that are eligible to deliver the Pfizer vaccine.
‘[We] will have 1300 [general practices] able to do that by the end of July,’ he said.
‘We already have 21 Commonwealth Vaccination Clinics that can administer Pfizer. There will be 70 of those in the first week of July, and we aim to have all 136 Pfizer-capable by the end of July.’
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Dr Daniel Thomas Byrne   18/06/2021 7:08:26 AM

The lower rebate for the second dose of AZ is now totally unfair. It is not quicker or easier to give the second dose anymore. A small gesture by the government to increase the rebate for dose two would be a sign of appreciation.
Yes - tell me I am dreaming.

Dr Dileep Singh   18/06/2021 8:17:54 AM

There has been 5-6 cases in 60 over age group as well .pfizer vaccination should be done for high risk people who are over 60 and has comorbidities This group is at highest risk of mortality if get infected and this should be on priority group other than health professionals and general practitioners

Dr P Scott   18/06/2021 11:29:55 AM

One of the most frustrating things about this new “swerve” in the guidelines is they came out in the middle of a business day with full lists of immunisations booked, and the media is the first ones to know. How about a heads up to doctors first, That way we can plan and look informed. I am sure there was wastage pre-drawn up vaccine when many people canceled or failed to show for appointments! Very disappointing.

Dr Iain   19/06/2021 7:21:47 AM

Go and talk to your GP if you are concerned? thanks professor but how about you do your job to keep GPs fully informed so we can advise our patients. The level of information flow is a disgrace, and I for one am not going to be able to advise anyone based on Paul Kelly's assertions. Where is the data? oh that's right we're adaptable so we probably don't need it. Maybe our president should focus more on getting us the information we need to do our jobs and less on how tired yet adaptable we are.

Dr Peter James Strickland   19/06/2021 10:58:39 AM

Being in the 75+ age group I would have much preferred the Pfizer vaccine for 3 reasons --- (1) it is a more effective vaccine, and especially after the first dose, and , (2) the 3 month delay for a 2nd dose of AZ has been a liability for many, and, (3) if we had had Pfizer or Moderna (mRNA vaccines) choices for everyone in the first place there would be greater herd immunity (if the number of doses needed were available), as controversies about thrombotic and capillary leakage scares would not have probably existed, and have convinced more to be vaccinated by now. Manufacture of mRNA vaccines in Australia seems to have been a problem, apart from all this varying advice from a multitude of "experts" over the last 15 months.