14 April 2021
Mass vaccination could rescue the snail-paced rollout
Australia’s vaccination program needs to change its tactics if we want to most of our population immunised against the deadly COVID-19 virus, say a growing number of health professionals.
Since the recent announcement that the AstraZeneca vaccine is no longer recommended for people under 50, GPs have already experienced an increase in vaccine hesitancy among the community.
The Department of Health told TMR this week they were in the process of modifying the COVID-19 vaccination program in light of the ATAGI advice.
“Our goal remains to ensure every Australian is vaccinated as early as possible, and 1a and 1b remain the priority populations,” said a DoH representative.
The DoH also conceded that health care workers under 50 in phase 1a and 1b would now be prioritised to receive a Pfizer vaccine.
But there was no additional information about how these healthcare workers would prove their eligibility when presenting at a Pfizer hub.
In the meantime, however, Australia is relying only on the services of general practices, respiratory clinics and Aboriginal Community Controlled Health services to bear the brunt of the vaccination program.
New modelling, yet to be published in a peer-reviewed journal, estimated that small GP clinics could deliver 100 vaccines a day, larger ones up to 300 and mass vaccination clinics up to 1400.
The authors used mathematical simulations of people waiting in line, known as stochastic queue network models, to assess the daily vaccination capacity for different venues.
Dr Mark Hanly (PhD), co-author and lecturer at the University of New South Wales centre for big data research, told TMR there was a delicate balance to strike when determining the throughput of a vaccination clinic.
The arrival intervals of patients, the service times and staff availability would all determine how many COVID vaccines might be able to be delivered at any given clinic.
“If you have fewer patient arrivals, then the overall processing time will be shorter and patients will be happy, because they’re not waiting long,” Dr Hanly said. “But the downside is that your staff will be underutilised, and you won’t be pushing up the capacity in terms of getting the daily vaccinations up.
“By comparison, if you increase the frequency of patient arrivals, the danger is that the system starts to break down, processing times spiral out of control and your staff are permanently in demand.”
Dr Hanly and his colleagues concluded that there were benefits to having vaccination in both GP clinics and mass vaccination hubs.
“GPs will know their patient’s history and, in some communities, people are most comfortable to go to their GP, so that’s really important,” he said.
“But a lot of people may not have a GP and might benefit from venues that have longer opening hours or more flexible appointment times, so if we can draw on the strengths of both types of facilities it’s likely to do better than one alone.”
GPs were well aware of the faults in the current national rollout. And since the latest advice from ATAGI, some GPs had already started suggesting alternative models to increase Australia’s vaccination throughput in the coming months.
Dr Andrew Taylor, a GP in Frankston Victoria, told TMR a mass vaccination drive to utilise the 40 million Pfizer doses secured by the federal government could be the solution to set Australia’s vaccination program on track.
“Let’s change everything and start a massive drive to vaccinate on a ‘Vaccination Day’,” he said.
“We can expect the Pfizer vaccine to arrive in airfreight parcels of millions of doses at a time, so we could plan to vaccinate one state at a time, all while moving the refrigeration and logistical capacity to meet the planes.”
Under this model, patients could receive a dose over two sessions, three weeks apart.
“It would work like a voting day, with some vaccination allowed before and after the ‘Vaccination Day’ in city centres,” Dr Taylor said.
Another model suggested to TMR earlier this week was for the government to add a phase 1c to the rollout as soon as possible, inviting all individuals over the age of 50 years to come forward for an AstraZeneca vaccine.
Dr Todd Cameron, a Victorian GP, told TMR a rethink was needed to ensure the public’s willingness to come forward to get vaccinated.
“The problem is that the inspiration to act might come from a catastrophic outbreak of COVID and if people aren’t motivated to do it on a preventative basis but they’re going to be motivated to do it on the basis of an outbreak, that’s worse,” he said.
In NSW, the government has announced plans to establish a stadium-sized immunisation hub in Sydney’s inner west, with an estimated capacity to vaccinate up to 30, 000 people a day.
NSW Health told TMR it planned to offer both AstraZeneca and Pfizer vaccines at the new mass vaccination facility.
But its supply would ultimately be determined by the federal government, with all state and territory supplies continuing to be regulated by the Commonwealth.
However, not everyone is supportive of a mass vaccination model either.
The Pharmacy Guild of Australia released a statement last week critiquing the stadium vaccination model proposed by NSW Health, saying it would be far easier for patients to receive the service at their community pharmacy.
“We’re trained and experienced in providing vaccination,” said the national president of the guild, Professor Trent Twomey, in a media statement.
“We’ve done the same mandatory COVID vaccination training as the GPs and nurses. We have the consult rooms set up and ready to go. We’re only down the road for many Australians, who visit us at least 18 times a year on average.”
But it stands to reason that the pharmacy sector might feel threatened by the suggestion of mass vaccination, with community pharmacies now set to face competition when they are onboarded in June, under phase 2a.