30 September 2020
COVID vaccine safety will need government digital monitoring
The impending immunisation program for COVID-19 is an opportunity to capitalise on digital health infrastructure Australia has put in place over recent years.
Digital health solutions have not been included early in the pandemic, and opportunities have been missed including communication of COVID-19 test results to patients and their GPs, the management of hotel quarantine, and contact tracing in Victoria.
It is highly likely there will be a mass immunisation program in Australia for COVID-19 some time in 2021. How this is managed and recorded will have huge consequences for all of us.
Obviously, the effectiveness of the vaccine(s) will be paramount, as will the proportion of the population that completes the schedule (if they require multiple doses or boosters).
There will also be a need to monitor not only the effectiveness of the program but any adverse reactions that may occur in the short and long term.
There may in future be a requirement for individuals to provide proof of immunisation to various organisations (workplaces, nursing homes, hospitals, schools, sporting arenas, perhaps even some restaurants, and large family gatherings). Proof of immunisation may even become a requirement for travel (similar to the requirements for yellow fever immunisation prior to travel through certain countries).
This means it will be critical to have good records. Australia already has the infrastructure necessary to support the needs of such a recording system. The Australian Immunisation Register (AIR), which began in 1996 as the Australian Childhood Immunisation Register, is specifically designed to record immunisations for all Australians. It is conveniently linked to My Health Record (MHR). About 90% of Australians already have a My Health Record and it is possible for people to opt in or out at any time.
All health professionals who administer a COVID-19 vaccine should be required to submit this information to the AIR. This will provide a system of recording all doses administered (regardless of location), monitoring and tracing adverse reactions, and allow individuals to prove their immunisation status when required.
Individuals can access the AIR directly or from within their MHR. Both are accessed through the My Gov website. Both can also be accessed via apps on their smartphones or other devices. App developers may see a benefit in upgrades that make priority access to COVID-19 vaccination status easier.
Making immunisation records available through the MHR will have other potential benefits as people start to realise they can access other health data already in this record. This includes health summaries uploaded by their usual GP, and blood test and other investigation results. To date, the value proposition of the MHR has not been well understood by the general population. The inclusion of COVID-19 immunisation status may help people appreciate this underused piece of national infrastructure as well as accelerate the use and uptake by health professionals.
GPs are already uploading immunisation records automatically into the AIR via their clinical software. Since GPs do most of the immunising in Australia, this will cover most of the COVID-19 vaccinations as well.
But a variety of other practitioners and organisations may end up administering the vaccines as well as GPs. This includes mass immunisation services in private workplaces and proposed public centres; pharmacies, which already vaccinate but do not universally upload them to the AIR; and even dentists, who have not previously engaged in immunisations but have recently proposed themselves for this role.
Vaccine records can be uploaded to the AIR via the web, but this is cumbersome. Streamlined electronic data entry software for every immunisation provider will greatly increase the likelihood that all COVID-19 vaccination data will be accurately captured.
We have time to develop this capability now using existing software tools with some modifications where required. This important record-keeping consideration needs to be front of mind when proposing various models of immunisation.
Simply being able to administer the vaccine alone will not be sufficient in terms of being to track the long-term sequelae of both the vaccination and the disease itself.
Dr Rob Hosking is chair of the RACGP Expert Committee Practice Technology and Management, a senior clinical lecturer at Deakin University and a GP practising in Victoria.
Dr Nathan Pinskier is the director of Medi7 General Practices and Onsite Doctor, the president of the General Practice Deputising Association, medical director of the DrDr After Hours Deputising Service and a member of the RACGP Expert Committee Practice Technology and Management.
Dr Oliver Frank is a Senior Research Fellow in the Discipline of General Practice at the Adelaide Medical School, University of Adelaide, and a GP practising in Adelaide.
The views in this article are entirely those of the authors and do not represent those of the organisations with which they are affiliated.