How can Australia’s vaccine rollout be repaired?

Anastasia Tsirtsakis

21/06/2021 5:18:20 PM

GPs reporting appointment cancellations and fridges full of unused AstraZeneca vaccines say more must be done to restore the public’s confidence.

Near-empty mass vaccination clinic in Melbourne.
Many patients have cancelled upcoming bookings for their AstraZeneca COVID vaccine. (Image: AAP)

Practice manager Anna Davidson was left gobsmacked on Thursday, when she saw reports of new guidance issued by the Australian Technical Advisory Group on Immunisation (ATAGI) for people aged 50–59 to receive the Pfizer vaccine.
Not long after the news was confirmed, she says reception at her Port Stephens practice was inundated with phone calls from confused and concerned patients.
‘We are yet again left holding the baby without knowing the black box within which we work,’ Ms Davidson told newsGP.
‘We’ll have to look at rescheduling appointments, juggling, changing, making more appointments for people with concerns. We will have questions about the vaccine in terms of safety and we will have questions in terms of efficacy.’
A similar scene unfolded at Dr Todd Cameron’s three Melbourne practices, leading him to postpone last weekend’s bookings after receiving a number of requests to cancel.
‘I just think that as more information is discussed that more of those people won’t turn up,’ he told newsGP.
‘So we prefer to wait it out because, to be blunt, the numbers now [are low and] it costs us money to run that clinic. We will lose money.
‘Whereas the last fortnight we were doing 300 doses a day on the weekend at each location and no problem filling them up. But I think those days are probably gone, and I doubt they’re coming back.’

Melbourne GP Dr Todd Cameron was forced to postpone last weekend’s bookings after a number of patients cancelled their bookings.
A big concern has been the resulting rise in vaccine hesitancy and the additional time the consent process will require.
While the Federal Government’s introduction of a new Medicare Benefits Schedule (MBS) item number for longer consultations has been hailed as a welcome step, both Dr Cameron and Ms Davidson say it is unlikely practices will be able to claim the PIP payment in many instances, as they expect a number of those aged 50–59 to cancel their second dose appointments.
‘It is now a practical impossibility for that to cover our costs,’ Ms Davidson said. ‘The reality is, we won’t give a second vaccine to a lot of patients because they either won’t come, [or are] holding out for an mRNA.
‘The $10 would barely have covered our costs if there were no issues with AstraZeneca, we got supply on time and we did the appointments. That’s what I did our calculations on how our practice can do this and still stay afloat – not make money, just not go bloody under.’
But even with longer consultation times, Dr Cameron fears it will be difficult to salvage AstraZeneca’s reputation, and says there is urgent need for a national public health campaign.
‘Anybody who thinks that the AstraZeneca can recover from this is ambitious,’ he said.
‘My perspective … is that the public is assuming that there are two classes of vaccine, and nobody wants to receive what they perceive to be second class treatment. The public are telling us loud and clear that they don’t want it, and the public messaging has been really awful.
‘It’s been left to us to do one-on-one, and doctors are tired. The receptionists are getting completely smashed by all of his work.
‘We really need a great diversity of voices, and that needs to happen in a hurry to get confidence restored in the program, let alone in the actual vaccines.’
Ms Davidson says the TGA’s initial ‘gag on doctors’, restricting GPs to only use Government promotional materials, was a setback in allowing GPs to communicate effectively with their patients.
‘[Patients] don’t want to hear what the Federal Government has to say, they want to hear what their GP has to say, what the practice has to say,’ she said.
‘They want to know: did the receptionist have the vaccine? Did the doctor’s mother have it? Did the doctor have it?’
Brisbane GP and practice owner Dr Maria Boulton says there is now a need for clear messaging on where and when those newly eligible for Pfizer will be able to access the vaccine.
Victorian COVID-19 testing commander Jeroen Weimar said on Friday that the 3000 people aged 50–59 who had bookings for the AstraZeneca vaccine would be given a Pfizer vaccine, but it remains unclear whether that includes those with appointments at GP clinics or just vaccination hubs.
‘They will be wondering what to do and where to access the Pfizer vaccine, and they will no doubt reach out to their GPs with these questions,’ Dr Boulton told newsGP. ‘We need clear communication from the federal and state and territory governments to the community on this.’

Brisbane GP and practice owner Dr Maria Boulton says there is a need for clear messaging on where and when newly eligible patients will be able to access the Pfizer vaccine.
On Monday, head of the National COVID Vaccine Taskforce Lieutenant General JJ Frewen said health authorities are currently operating in a ‘resource constrained environment’ in relation to supplies of the Pfizer vaccine, but noted that availability will increase from August.
‘On current forecasts, we are looking forward to ramp up availability of Pfizer through August into September and into October,’ he said.
‘So as we get into that third-quarter, fourth-quarter, we think we will have far freer flows of Pfizer and start to be able to allocate that more freely but for now, we have to manage the resources that we've got against the highest priorities we’ve got.’
The next step, Dr Boulton says, is supporting the transition of practices who have expressed interest in administering Pfizer.
‘We need supply and delivery to go smoothly. This is just a start, of course,’ she said.   
Dr Cameron agrees and says the next step should be getting Pfizer doses into clinic fridges as soon as possible.
‘We haven’t had the easiest vaccine to push. So they just need to give us the tools and the environments for success,’ he said. ‘That means getting the lower risk vaccines into our hands, so we can get them into arms.’
Ms Davidson’s practice has applied to offer Pfizer, but says they have yet to hear any word on the progress of their application.
‘There’s no reason at all we can’t give Pfizer,’ she said. ‘In fact, we could have given it to start with.
‘Why didn’t they give Pfizer to general practices in the very first place where it could have been made a point of service provision decision … based on the available evidence, at that point, with the time for consent.
‘That is how every vaccine is given out.  But they designed their own system; they didn’t use existing structures, which already work.’
GP Dr Nick Martin says the change in guidance has also led to anxiety around AstraZeneca for patients aged 60 and over.
‘I think my receptionists are going to cry. Patients cancelling, rebooking for a Pfizer vaccine that will trickle in, patients worried about second AZ doses, patients over 60 demanding anything other than AZ,’ he tweeted.
Given the various changes and uncertainty surrounding the rollout, Dr Boulton said it is important to acknowledge the hard work of GPs, nurses and other staff.
‘Many are working harder than ever, taking less holidays and spending more time keeping up with the ever-changing data,’ she said.
‘They are also dealing with an increase in mental health presentations, as well as safety concerns if working in a hotspot.
‘It is important we acknowledge their contribution and support them so they can continue to do what they do, which is to provide excellent evidence-based care for their patients.’
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Dr Ian   22/06/2021 8:01:50 AM

You have to offer D Dimer to everyone who has symptoms persisting after 48 hours if they get Astrazeneca and space the mRNA vaccines first and second to six weeks .

Dr Ben Lloyd Balzer Snr, GP   22/06/2021 9:54:40 AM

Who is driving the smear campaign against the AstraZeneca vaccine and why does the manufacturer seem silent in defending their own product. The US VAERS Vaccine Adverse Event Reporting System ( ) informs us that there have been 5,078 deaths reported following COVID vaccines there, including (22/06/2021 9.42am AEST). 417 from Janssen, 2398 from Moderna, 2238 from Pfizer and 25 unknown manufacturer.
Plus 2442 cases reported as Bells palsy, 73 reported as facial nerve palsy, 797 cases of neuropathy, 290 cases of Gullain Barre.
So the Pfizer and other vaccines may have similar risks to the AstraZeneca, despite the enormous Trumpesque spin about AZ,