GPs key to opening up ‘fortress Australia’

It has been projected that Australia will look to open its borders in the first half of 2022, a move that the recently released Federal Budget made clear will be heavily reliant on a successful vaccination campaign.
 
A number of reports subsequently emerged over the weekend with warnings from various public health officials suggesting that the abandonment of ‘fortress Australia’ – and therefore the return of COVID – will occur once vaccinations have been widely offered to the community.
 
‘It’s going to be difficult as a nation because we are so comfortable at the moment because we did so well in restricting the numbers [of COVID-19 cases],’ Dr Nick Coatsworth, former Deputy Chief Health Officer, said.
 
‘What vaccination coverage would the [Federal] Government accept, and would the medical profession suggest, is adequate for opening borders? We don’t know that and I think we need to be honest about that.’
 
Victoria’s Chief Health Officer (CHO) Professor Brett Sutton has also been quoted as saying that Australia’s success in virtually eliminating community transmission for long periods of the pandemic has led to a lack of urgency among the public in wanting to get vaccinated against COVID-19.
 
‘We need to somehow communicate to the public that we’ve gotten to a place of complacency because we’ve driven transmission to zero but we will face newly emerging transmission, and a critical juncture where we need to make a call on letting it run,’ he said.
 
‘I think that’ll be when we’ve got as high vaccination coverage for the adult population as we can possibly get … in order to open up Australia to world travel and arrivals so that our education sector, tourism sector and all of the other kinds of compassionate reasons for us to see family and friends overseas can come to the fore.’
 
Associate Professor Charlotte Hespe, Chair of RACGP NSW&ACT and member of the college’s COVID Working Group, agrees that there appears to be a lack of urgency among the community, but told newsGP that the best way to address vaccine hesitancy is to draw on the expertise of GPs and support them to help educate patients.
 
‘I understand where some [of the health officials] might be coming from, but I think that GPs do actually play a fairly important role in persuading people to get vaccinated sooner than later,’ Associate Professor Hespe told newsGP.
 
‘I’m constantly having conversations about COVID [vaccine] hesitancy where I’m persuading people that they should go ahead now rather than waiting because there is this conversation that people go over in their heads: “I’ll get vaccinated if COVID comes in”. Rather than saying: “I’m going to get vaccinated now so that it doesn’t matter if COVID comes in, and we can move forward sooner”.’
 
A new global report, led by Imperial College London, tracking changing health behaviours and attitudes in 29 countries over the past 12 months found willingness to get vaccinated against COVID-19 has risen over time – except in Australia.
 
The decline is associated with concerns around vaccine side effects, coinciding with reports over blood clots linked to the AstraZeneca vaccine and the subsequent change in advice from the Australian Technical Advisory Group on Immunisation (ATAGI) for people aged under 50, which GPs say has led to some hesitancy in older cohorts. 
 
‘There is a false sense that AstraZeneca isn’t a good vaccine for people over 50, which is just nonsense,’ Associate Professor Hespe said.
 
‘It’s got some risks associated with it, but actually, so do all the vaccines on the market. Realistically, the risk of COVID, when you do see what happens when COVID gets into a country that isn’t vaccinated, is appalling.’
 
While GPs are often able to help combat vaccine hesitancy, rising apprehension in the community has also led to reports of longer consultation times, with some vaccine consent appointments now ballooning out to 45 minutes.
 
But as it stands, the current Medicare Benefits Schedule (MBS) item numbers designed to cover costs of a vaccine suitability assessment are still only equivalent to a Level A attendance.
 
To ensure GPs have the time to adequately assist patients and be remunerated for their work, the RACGP is advocating for an MBS item number for COVID-19 vaccine counselling, equivalent to a Level B.
 
‘The whole item number for doing the COVID vaccine was designed when it was seen as being a mass vaccination issue rather than this longer protracted conversation,’ Associate Professor Hespe said.
 
‘It’s a Level A payment, so it’s less than five minutes of your time as a GP, so it’s pretty dismal and GPs are feeling a bit caught about how much time are they allowed to counsel.
 
‘So we are trying to obtain an item number for COVID vaccine counselling. The idea is that we get a Level B consultation that enables time for a proper conversation prior to you actually consenting and vaccinating.’
 
However, in helping to ease the concerns of the general public, Associate Professor Hespe says the general practice community need to be on the same page when it comes to the end goal.
 
‘We need GPs to come on board rather than encouraging people to wait, which I think a lot of my colleagues are, quite honestly, because they’re in that same mindset that “we’re not at risk at the moment, so you’ve got plenty of time to think about it”,’ she said.
 
‘Well do we have plenty of time to think about it? Look at Taiwan at the moment, look at what’s happening in India.’
 
Dr Coatsworth shared the sentiment, saying that the medical profession has an important role to play in reassuring people who have concerns about the new COVID vaccines.
 
‘[There are] doctors who have been anti-AstraZeneca since the start of this year, misquoting and misrepresenting the phase 3 trial data ... and in my view substantially undermining the national program,’ he said.
 
‘We were sort of primed already as a community to think that Pfizer was the better vaccine by some prominent voices in the media, and the reality was that was a misrepresentation of the data.’
 
For GPs that do have their own questions about the risks and benefit of a vaccine, Associate Professor Hespe encourages them to do their own research and look at the data.
 
‘Why is it that AstraZeneca has been getting all of this attention? Go and look at the data. Is the data that bad? No, actually, the data is very good,’ she said.
 
‘Yes, there are risks, but there’s no vaccine that we give that doesn’t. How many GPs have actually gone into that level of detail about all the other vaccines that they give to their patients? And do they encourage them to do it? Of course they do.’
 
Since GPs joined the rollout on 22 March they have demonstrated their reach. Out of 3.1 million doses administered to date, general practice is responsible for more than 1.7 million.  
 
Associate Professor Hespe says Australians should look beyond their own borders to get some perspective.
 
‘We’re put in this dilemma because we don’t have any infection; we’ve done too good a job,’ she said.
 
‘I don’t want any of my patients in my community or my family members to be put at risk from COVID when we’ve actually got the pathway to getting as many people as possible vaccinated with no infection.
 
‘We’re so fortunate we’ve got all of these vaccines. Sure, it’s not rolling out as fast as we might like it, but that does give us the opportunity to have these conversations. We are the people at the front line to … reassure our patients that this is the right way forward, rather than us sitting in this “Never Never Land” that is actually very risky.
 
‘So it’s about reframing the story because we’re all stuck in this [mindset of] amplifying the risk rather than actually looking at the whys; why would you want to get vaccinated? Well, it seems pretty simple and straightforward to me.’
 
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