What is the future for COVID-19 boosters in aged care?

The rollout of the Federal Government’s COVID-19 booster program officially opened earlier this month, with aged care and disability home residents cited as a priority. 
 
The first boosters were delivered ahead of that date, the Federal Minister for Health and Aged Care Greg Hunt confirmed last month, with an elderly patient in Geelong reportedly at the very front of the queue for the program.
 
The broader question of whether there will be an ongoing need for COVID-19 vaccinations beyond the existing booster program was also raised by Minister Hunt last weekend.
 
In a press conference he suggested more vaccine doses will probably be required in residential aged care settings, as well as the older population more broadly.
 
‘I spoke with Sir Andrew Pollard a week ago today, from the Oxford Vaccines Group, along with Dame Sarah Gilbert, one of the leaders in that program,’ Minister Hunt told reporters on Sunday.
 
‘And his view is that the world doesn’t know yet, but it was more likely than not that we may require updates for older or immune-compromised Australians and people around the world.
 
‘The world is learning as to whether or not there are more doses that will be required beyond the third shot, or the booster.’
 
He said the Government has secured adequate supplies, no matter what decision on further vaccine doses is taken in the future, citing orders of 85 million Pfizer doses, alongside 51 million Novavax and further 10 million Moderna, as well as existing supplies of AstraZeneca.
 
Private providers
Could GPs play a bigger role if medical advice indicates booster doses should continue in the aged care sector?
 
The involvement of general practice was limited in the initial rollout to aged care residents, with the Government instead awarding a series of large contracts to private providers, including Aspen Medical, Healthcare Australia, Sonic Healthcare and International SOS.  
 
There were widespread problems reported, including issues with supply, obtaining informed consent, and residents missing out on doses due to being away when providers visited. There were also reported difficulties in vaccinating people who subsequently moved to residential aged care facilities.
 
Aged care workers were not immunised at the same time as residents, with further Commonwealth contracts agreed to address the issue after the states and territories made vaccination mandatory for the sector.
 
In June GPs were given an incentive to become more involved with the introduction of an additional fee to visit aged care facilities.
 
The Chair of RACGP Specific Interests Aged Care, Dr Khayyam Altaf, has strongly advocated for an increased role for general practice in the rollout of the vaccination program in RACFs.
 
‘For me, there’s absolutely no sense in getting private providers to do this,’ he told newsGP. ‘We know our patients, we can have the discussions at the time of the vaccination.
 
‘We know who is appropriate for it. We can have the discussions with the family members. And we’ll be there present if there are any adverse reactions.’
 
The Department of Health (DoH) issued a statement in response to a newsGP inquiry about the potential for general practice’s involvement in this latest phase of the aged care booster program.
 
A spokesperson said Primary Health Networks ‘are assisting in the co-ordination for boosters in residential aged care and identifying where GPs could support this program’.
 
‘This will supplement the work being undertaken by the vaccination providers, which have been delivering the vaccinations for both residents and staff, as well as some facilities also now undertaking the vaccinations through their own arrangements,’ the spokesperson said.
 
‘In some instances, this will be in partnership with a local GP.’
 
In-reach clinics
However, most of the vaccinations are again expected to be carried out by private contractors at this stage of the booster program.
 
Details published on the Australian Government tenders website outline a series of extensions and contract amendments for the original suppliers. A Government snapshot of COVID-19 outbreaks published last week also confirms the majority will be delivered via contractors.
 
‘Consistent with the initial vaccine rollout to residential aged care, the booster program will start with in-reach clinics, delivered primarily by vaccine administration providers under contract arrangements to the Commonwealth,’ the document says.
 
It stated there had been 154 deaths recorded in RACFs this year, with 13% of all aged care homes having at least one reported case among residents and staff. The Australian death rate from COVID-19 stood at 0.46%, it said, compared to Canada which has registered 18 times more deaths overall.
 
With aged care residents likely to be one of the primary concerns as the pandemic continues and the intensity of the initial vaccine rollout eases, Dr Altaf says there is a strong case for giving COVID-19 vaccination responsibilities back to general practice in the future.
 
‘Then we can coordinate as we do every year with our flu vaccines and the [other] vaccines we can give,’ he said.
 
‘Aged care residents are the most vulnerable [and] we’re providing optimum care all the time anyway.’
 
Dr Altaf believes the success of the booster program, both in aged care facilities and in older residents at home, will play a critical part in the pandemic response.
 
‘To be infected with COVID-19 if you’re a vulnerable individual is catastrophic,’ he said. ‘I’ve had patients who have died very quickly with COVID. Otherwise, it was unexpected, so it’s clear that it’s a dangerous virus.
 
‘We need to make sure we keep that protection level up.’
 
There are approximately 190,000 aged care home residents in Australia, who had received a total of 328,242 doses as of 12 November.
 
According to the latest vaccine rollout figures (current as of 14 November), there have been 257,462 third doses, including for the severely immunosuppressed as well as boosters, now administered overall in Australia.
 
The DoH did not address an inquiry from newsGP about how many of those doses had been delivered in RACFs so far, nor a request for the overall cost of the private in-reach vaccination program to the sector.
 
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