Controversy characterises the current, somewhat heated, discussions about how to use the vaccines available to us. While we hope to eventually employ at least four effective vaccines at the moment our choice is limited to one of two, the AstraZenica vaccine which we can manufacture here and the Pfizer vaccine which we need to import.
Vaccination goals
We face the challenge of providing two doses of a highly effective anti SARS-COV-2 vaccine to 80% of our population ,which would include all children over the age of 5, in the shortest possible time. This latter point is important for a vaccination program that is delivered over many months or even years will see varying levels of immunity among our population that can be taken advantage of by the SARS virus.
If achieved the vaccinated will be protected and our community will be one in which it is very difficult for enough virus to infect, multiply and create new variations that provide it with better survival prospects.
However, adequately pursuing these goals at this time are made more difficult as the reports of side-effects with the AZ vaccine undermine the public’s confidence in this preparation.
AstraZenica side effects
Not long after the AZ vaccine entered service a rare but potentially serious unwanted effect was reported. Some recipients developed serious blood clots in their blood vessels followed by severe spontaneous bleeding that could be fatal. A number of deaths were reported as well as the incidence being more common in younger recipients.
In Australia such was the publicity given to this finding, without a simultaneous emphasis on the effectiveness of the vaccine, that public confidence in the vaccine plummeted. This was enhanced when the expert committee advising our government’s said that we should restrict the use of the AZ vaccine to those 50 years or older.
When Australian data showed that in those aged between 50 and 59 the incidence of clotting was 2.7 cases per 100,000 inoculations our expert advisory committee recommended that only people over 60 should be given that AZ vaccine. The incidence among 60 to 69 and 70 and 79 was 1.4 and 1.8 per 100,000 doses respectively.
Has any Australian died because of this AZ complication? Among 60 cases of clotting we have had 2 deaths, an incidence of about 1 in a million.
As could have been suspected hundreds of Australians in their 60s and 70s reacted negatively to this decision. If the AZ vaccine is not good enough for a 50 year old why should I have the AZ vaccine they voiced as they cancelled appointments for vaccination with their GPs!
For many confidence was further eroded when the government announced it would indemnify GPs so that they could not be held responsible for vaccine side effects. As is done in many countries we should be insuring patients not doctors.
Now as the data reported above was being collected two important developments occurred which must now be considered as one makes a decision about vaccination intentions.
The first was the discovery of the mechanism by which the vaccine causes clotting. Probably for genetic reasons a few, very few, people vaccinated with the AZ vaccine make antibodies that can attack cells in our blood stream called platelets. These guys are responsible for making sure blood does not leak out of our blood vessels. They plug any breech with a clot they make by sticking together. The antibodies in question make platelets clot.
The second was realisation that early in the process certain anti-coagulation drugs (not Heparin and not aspirin) but gammaglobulin could stop the clotting.
The Prime Minister speaks
As criticism of our low level of immunisations mounted, onto our television screens ‘out of the blue’, came the PM with a new message. Anyone over the age of 18 who wanted to do so could be immunised with the AZ vaccine. Just go to your GP, learn about any risks and if you still want the vaccine you can have it.
Turns out the PM’s peak advisory body (ATAGI) did not know about this nor had the AMA or The Royal College of General Practitioners been given any advanced warning of this new edict. The ATAGI reiterated its “over 60 AZ Under 60 Pfizer” stance while the Commonwealth’s Chief Medical Officer said that was still the advice but if people so wished they could have the AZ vaccine.
Confusion and frustration dominated comments in the media. GPs were swamped with phone calls with many young people wanting to be vaccinated. Ironically we have many Australians over 60, who are most vulnerable to life threatening infections, cancelling appointments for the AZ vaccine.
Advising all people under 60 who are now considering having the AZ vaccine to book an appointment with ‘their’ GP to discuss the risks and benefits sounds good but is in fact problematic. Because our Primary Care system is not structured to address the prevention of illness many Australians, especially young ones, who are well, do not have a doctor who is ‘their GP’. Most GP practices are unusually busy at the moment and the system does not have the capacity to absorb millions of at least 20 minute consultations to discuss the risks/benefits of the AZ vaccine.
The ATAGI has a website and should place the information needed to help an individual make an informed choice re vaccination there, on all social media platforms and advertise in media outlets that this is available.
Recently I looked at all the Covid websites posted by all our state and territory governments. In general they are confusing, often contradictory and in need of an update. While so doing I dialled the NSW dedicated telephone line for people with Covid related questions. After 45 minutes of “All our representatives are busy at the moment but will be with you shortly” I gave up.
Facts important in decision making re immunisation with the AZ vaccine
Developing blood clots after vaccinations is very uncommon. For people under 40 it is a problem for about 3 people per 100,000 vaccinations. For older populations its even less ( 1.4-1.8 per 100,000 vaccinations). To date 1-2 people per million vaccinated have died from the complication.
We expect dangerous consequences from blood clotting to decrease significantly as we now understand the cause of the condition and can treat it successfully.
If you have had no problems after the first dose of the vaccine there is an even smaller chance that you will have problems after the second injection.
If you experience the onset of headaches, abdominal pain, nausea, shortness of breath, a swollen leg or a rash immediately report this to your GP or visit an emergency department. Blood tests that can tell if your symptoms are due to vaccine induced complication are available as is treatment if they are positive.
If you have a chronic illness such as diabetes, lung, heart or kidney disease no matter your age, you should be vaccinated now. You are eligible for the Pfizer vaccine but availability is a problem and if not available to you use the AZ vaccine.
All states run vaccination hubs administering Pfizer vaccine to people over 40 but under 60 and the AZ vaccine to those over 60. There is however a serious shortage of the Pfizer vaccine which is likely to continue until at least September and maybe longer. They will not be offering AZ vaccine to people under 60 at the moment so you will need to have a GP immunise you if you are aged 18 to 40 or you are aged 40 to 60 but can’t get the Pfizer vaccine.
We do need to speed up the vaccination program for without 80% of Australians vaccinated we will continue to struggle with restrictions including lockdowns and problems with international travel. Many voices have been heard in recent days saying that for the benefit of the community they want to be vaccinated now and they find the AZ risks acceptable.
Conclusion
Its surprising and disappointing that so far Australia has failed to mount an effective vaccination program with the momentum needed to return to pre-Covid life. With the availability of sufficient doses of the Pfizer vaccine to quickly establish ‘herd immunity’ in Australia problematic, an acceleration of our immunisation program would require the use of the readily available AstraZenica vaccine for people under 60 yrs. Because of the very rare but potentially serious side-effects associated with this vaccine there is an ethical obligation for government to facilitate the acquisition of the knowledge that allows individuals to make an informed decision about their vaccination.
Professor John Dwyer is an Emeritus Professor of Medicine at UNSW and the founder of the Australian Healthcare Reform Alliance.
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