Can we drop the phases already?

GPs say keeping Pfizer for 40-49s is paradoxical and creates an administrative nightmare.

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GPs are pleading for a more streamlined vaccination strategy, saying that since younger people are coming forward for vaccination, it no longer makes sense to restrict Pfizer to those over 40.

They also say the advice to check the Australian Immunisation Register before every patient is onerous and impractical.

At a Department of Health webinar today, GPs were asking why the 40-49 cohort remained eligible for Pfizer, while all younger individuals were still restricted to AstraZeneca.

Some immunisation providers also said given the rare but serious side effect of TTS from AstraZeneca was more common in those under 40 years, the government should consider dropping its eligibility restrictions on Pfizer altogether. 

“Why are the 40-59 year old cohort getting the Pfizer and the younger cohort getting AstraZeneca?,” said one GP on the webinar. “Should it not be the other way around?”

One reason Pfizer was originally preferred for phase 1a and 1b populations because of its much shorter three-week interval between first and second doses.

This was more attractive for priority populations, such as quarantine workers, who would have reached immunity much sooner than if they had to wait three months for a second dose of AstraZeneca.   

But now in outbreak settings, there is very little time difference between the two vaccines, with the second dose of AstraZeneca recommended as soon as four weeks following the first dose.

In the meantime, practices are facing increased pressure to allocate vaccination appointments to their patients while remaining restricted by government advice.

“Please open up the next phase so that under 40s can get their Pfizer vaccine now,” said one GP.

“My staff are at their wits’ end arguing with people about when they can get [Pfizer] – we need simplification.”

Professor Michael Kidd, Deputy Chief Medical Officer at the DoH, said that the official advice was to refer people to the vaccine eligibility checker.

But he also admitted it wouldn’t help when doctors were having an argument in their practice.

Dr Lucas de Toca, First Assistant Secretary of the DoH covid-19 Primary Care Response, said the decision to change vaccine eligibility was ultimately the decision of the National Cabinet.

“We expect that eligibility will keep opening in the next few months and hopefully we’ll reach a point where we collapse eligibility and we won’t need things like the eligibility checker,” he said.

Until that time, Dr de Toca said the designated groups should be the priority for Pfizer.

“There are still aged care workers that are unvaccinated,” he said.

In June it was announced that individuals employed in aged care would be expected to have a first dose of a covid vaccine by mid September, or face being banned from the workplace.

To sweeten the deal of mandatory vaccination in this sector, and recognising community hesitancy about AstraZeneca, the government agreed to open up Pfizer doses to aged care workers. 

Dr de Toca said the government also wanted a strong focus on making sure that Aboriginal and Torres Strait Islander people had access to the Pfizer vaccine as a priority population.

“It is still important that we maintain the prioritisation, but it is expected that there will be a sequential opening [of the program and that those] 30-39 will most likely be the next group,” he said.

“That’s not far away, but it’s ultimately up to National Cabinet to make that call.”

On another contentious point, the DoH also said GPs should be checking the Australian Immunisation Register for each vaccine patient as it had concerns about covid jabs being administered inappropriately.

Frances Rice, the DoH Senior Nurse Advisor, said the government had become aware of some people receiving more than two doses of covid vaccine, and some receiving other immunisations on the same day as their covid vaccine.

“It’s very important that everyone checks the Australian Immunisation Register prior to giving vaccine doses,” said Ms Rice.

“We need to know that we are maintaining a seven-day break in between other vaccinations.”

But this sparked a flurry of comments from GPs.

“I don’t know what others think but checking [the AIR] for every patient is not practical in general practice,” one GP said in response.

Not only is the Provider Digital Access (PRODA) from Services Australia complex, but the burden of additional administration could be costly and time intensive.

“I am doing about 150 [immunisations] per day,” another GP said. “Do you really expect me to check on AIR with each one?”