GPs may vaccinate over-50s ahead of schedule

Adults originally allocated to phase 2a could start coming forward for an AstraZeneca shot in the coming weeks.

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The role of GPs appears likely to narrow in focus to giving over-50s the AstraZeneca vaccine, with most younger people to receive Pfizer through state sites later in the year.

Following a meeting with the National Cabinet on Monday, Prime Minister Scott Morrison announced that the commonwealth, states and territories agreed “in-principle” to more changes to the COVID-19 vaccination plan.

The changes, which are set to be put forward for approval at the next National Cabinet meeting on Thursday, include bringing forward the vaccination timeline for Australians 50 years and older.

This would mean all those adults originally allocated to phase 2a of the vaccination rollout could start coming forward to receive an AstraZeneca vaccine in the coming weeks.

It seems that general practice will continue to be the primary service administering AstraZeneca – now with the ability to open their appointments to a larger section of the population.

But there is still no commitment to increasing the dose allocation of general practices, with a majority of clinics still receiving as few as 50 doses per week.

Despite these major logistical questions, the picture of what our vaccine program might look like in the coming months is slowly coming into focus.

“National Cabinet reinforced that general practice will continue to be the primary model of rolling out vaccinations for Australians 50 years of age and older, with states and territories to consider options to supplement rollout through expanded state vaccination centres,” said Mr Morrison in a press statement.

TMR understands that the rollout will continue on two tracks, through general practice and through larger state-based hospital hubs and mass-vaccination sites.

Under these two systems, those over the age of 50 will be prioritised in the coming months to attend a general practice, GP respiratory clinic or Aboriginal Community Controlled Health Organisation to receive the AstraZeneca vaccine.

At the same time, existing state-based Pfizer hubs will continue to vaccinate those vulnerable individuals originally allocated to receive a vaccine under phase 1a, including residential aged care facility residents.

The Department of Health told TMR last week that those hubs would also prioritise any health workers under the age of 50 for whom it was preferential to receive a Pfizer vaccine.

The National Cabinet meeting also discussed the role for more state and territory-operated vaccination sites including mass vaccination sites, particularly as supplies increase.

It’s understood that when additional Pfizer doses arrive in Australia in the final quarter of the year, mass vaccination clinics could be the primary format to offer this vaccine to the balance of the population under 50.

With so many changes afoot, TMR asked the AMA what provisions it would like to see put in place to protect general practices participating in the program.

President Dr Omar Khorshid said the AMA supported the decision for AstraZeneca to be brought forward for over-50s – but that both supplies and public confidence needed to be bolstered so GPs could get vaccines in the arms of patients.

“Vaccine supply for GPs needs to be assured and we need to ensure that through the MBS, patients can talk to their trusted GP on the decision to get vaccinated and the benefits of the vaccination,” he told TMR.

As part of instilling confidence, Dr Khorshid said the AMA would continue to work on indemnity issues with the government and medical defence organisations.

“MDOs have assured the AMA that doctors are covered by their policies,” he said. “We will look out for any other potential risks to GPs during the roll out and advise to the public that GPs are most skilled in explaining the vaccine and increasing confidence.”

5pm update: An AMA representative confirmed that the association was lobbying the government to raise vaccination rebates.

“For those patients who need to spend longer discussing the risks and benefits of a COVID-19 vaccination with their GP – this is even more important following the recent ATAGI decision to preference Pfizer over AstraZeneca for patients under 50,” they said.

“This has increased the level of vaccine hesitancy and GPs are finding that they need to spend a lot more time with patients as a result.”

GPs are reporting an increase in long consults with patients who were vaccine-hesitant because of the rare but serious risk of clotting from the AstraZeneca vaccine – as well as appointment cancellations.

The DoH has previously said it will review the GP vaccine rebates as a part of its larger “recalibration” of the national rollout strategy.

In the meantime, the Pharmacy Guild of Australia is continuing to lobby against the idea of Australia needing mass vaccination centres.

In a rather contradictory interview with News Corp outlets at the weekend, national president Professor Trent Twomey said that in the interest of achieving herd immunity, the involvement of community pharmacies in the rollout should be moved forward.

However, Professor Twomey also said that “Soviet-style” mass vaccination hubs should be only used as “a measure of last resort”.