Australia's vaccine rollout pivots with new advice about AstraZeneca vaccine

Burnet Institute

09 April, 2021

Professor Brendan Crabb AC with Matt Wordsworth, ABC TV Afternoon Briefing

In a major development in Australia’s vaccine rollout, the Australian Technical Advisory Group on Immunisation (ATAGI) advised the Federal Government that the Pfizer vaccine should now be preferred over the AstraZeneca vaccine for anyone under 50 years of age.

The advice by ATAGI followed further evidence of a rare but serious side effect involving thrombosis (clotting) with thrombocytopenia (low blood platelet count) following receipt of COVID-19 Vaccine AstraZeneca.

The Australian Government also responded by securing an additional 20 million doses of Pfizer vaccine, due to arrive by the last quarter of 2021.

So what does this mean for Australians thinking about being vaccinated and the risk of vaccine hesitancy?

Director and CEO of the Burnet Institute, Professor Brendan Crabb AC, spoke with Matt Wordsworth on ABC TV’s Afternoon Briefing about the decision, the rising global cases, whether we will need to have annual vaccinations, the threat of variants, and whether he will still get the AstraZeneca vaccine.

Matt Wordsworth:
Firstly, let’s get your opinion on the decision to issue that advice about AstraZeneca for people under 50.

Professor Brendan Crabb AC

The one thing Australia has is very good regulatory authorities, several of them. And the second good thing is the government really listens to them. And so this is a really considered opinion for Australia, based on a very rare but real complication it looks like. And in a circumstance like Australia, where we don’t have any COVID in the community at all, the risk benefit analysis comes out that way. So it’s disappointing, I know that it will most likely engender additional vaccine hesitancy and I hope that that doesn’t last long, because this is still a very good vaccine, an important part of our arsenal and of the world’s arsenal to combat COVID.

Matt Wordsworth, ABC
And so why didn’t something like this come out in the trials for AstraZeneca? Or is that just a factor of the speed with which we are working?

Professor Brendan Crabb AC
No, it’s got nothing to do with the speed, it’s got to do with the numbers. So the numbers of people in a clinical trial are in the 10s of 1000s, maybe a few more than 10s of 1000s. And, something very rare doesn’t reveal itself in those numbers. So it’s not until post-release, as we call it at trials, where something is approved as safe, that you end up in the millions. And that’s what’s happened here. When there’s been 10 or 20 million people immunised with the AstraZeneca vaccine, these very rare, you know, literally 1-2-3 or four in a million cases have popped up. And you know, can reveal themselves. And so this is not an unusual circumstance at all. What’s unusual is to watch this happening in real time in the public eye, medical interventions. vaccines, drugs, often have very rare side effects that reveal themselves in this way, just not so publicly. So it’s really unfortunate that it’s happened. But I expect more of these things to happen over the year with different products, not necessarily just AstraZeneca. I expect advice to change for various reasons as our own circumstance in Australia changes such as we get an incursion of COVID, for example. So this is pretty normal. But I understand the concern it’s causing so many people.

Matt Wordsworth, ABC
One of the other messages the Prime Minister had was that this is not a ban on taking AstraZeneca if you’re under 50. New South Wales Premier, Gladys Berejiklian, said she is 50. She’s had one dose of AstraZeneca and is completely comfortable getting the second dose. So if you’re out there, and you’re 35, you’re 45, you’re 28 should you have AstraZeneca?

Professor Brendan Crabb AC
Well, I was due to have it on Monday, I’m 54. And certainly it doesn’t change my inclination to go and get the vaccine. As I say it’s a very good and very safe vaccine.

This advice is out of an abundance of caution. The reason why it’s not a ban is that there’s every chance it will change as we learn more about the vaccine. And as our circumstance in Australia changes.

Professor Brendan Crabb AC If you’re in Great Britain, the age is under 30, not under 50 as it is here. And that’s because people between 30 and 50 have a much higher risk of being infected in Great Britain than they do in Australia. So I do expect advice to change. I personally will be getting it. I’m in the over 50 bracket. So you have to ask people under 50. We’re talking about a one in a million, very severe, potentially life-threatening circumstance. And you don’t want to be that one-in-a-million. But, the benefit obviously of being vaccinated especially when there’s lots of COVID around is much much higher than that. So yes, I’d be going getting vaccinated, be encouraging people to not hesitate for a moment to do so if they get offered.

Australia responds to the advice by ATAGI by securing an additional 20 million Pfizer vaccine doses following AstraZeneca concerns for under 50s.

Matt Wordsworth, ABC
The Chief Medical Officer, Professor Paul Kelly, ran through a list of other things that were very interesting questions we still need answers for. Like, how do these variants react to the vaccine, the UK variant, the South African variant? Does the vaccine work on them?

Professor Brendan Crabb AC
Well, I think what Paul Kelly has hit on then is what I consider to be the most important problem. You know, we have a lot of focus on our vaccine rollout. But the bigger problem is emergence of variants that threaten all vaccines, not just the AstraZeneca vaccine, but all of the vaccines.

The reason why we’re getting variants emerging is we have so much COVID in the world. COVID is getting worse in the world, not better. It’s getting back to levels, around 500,000 cases a day, happening at the moment. So extraordinarily high numbers and that drives the emergence of variants. So the biggest risk we have in Australia to our vaccine program is these other variants.

Professor Brendan Crabb AC
AstraZeneca possibly doesn’t work quite as well against variants, as far as Pfizer and other vaccines, but it’s still effective especially if taken at the right dosing intervals. But variants will continue to emerge, and there’ll be more and more, they will be better at escaping immunity. So the best thing we can do in Australia is help other countries in our region, starting with Papua New Guinea, at getting virus numbers down so variants don’t emerge so readily or else our vaccine program won’t work no matter how fast people are vaccinated.

Matt Wordsworth, ABC
So Professor Brendan Crabb, you’re an infectious infectious diseases expert. So could we be in a situation where we’re getting annual COVID shots like we get annual flu shots?

Professor Brendan Crabb AC
Yes, we could be whether it’s annual or biannual, but periodic, I think that’s very likely to settle into into that way of things. The coronavirus is not as variable as an influenza virus for various reasons. But we have learned that it is variable. Every virus is susceptible to evolution. And really, the folly, I guess, of letting the virus run in so many countries in the world has meant we’ve got a much higher frequency of these variants of concern, ones that transmit more readily, and ones that escape immunity more readily than they otherwise would have if the numbers have been kept low. So unfortunately, we’re in that situation and we need to get the numbers down. It’s a straight numbers game.

I think it’s likely we will get boosted every year or two or three with probably a new vaccine that covers the new variants.

Matt Wordsworth, ABC
And Professor Crabb, we’re just reporting in breaking news that the Torres Cape vaccination rollout has been paused while health service works through the details of the new recommendations they say are under 50. And they’re of course taking the AstraZeneca. Do you think that’s an overreaction then?

Professor Brendan Crabb AC
No, I think pausing is sensible. And just taking stock of what the announcement is. And, you know, there’s a large part of bringing the community up to speed with what’s happening. You know, I think the worst part of these announcements is that people who don’t live and breathe this every day, like I do, get understandably really concerned about it. So now I think pausing, communicating, people then understanding the risks and I think once people do really understand the circumstance, then things can can restart again. It is, as I say, a very safe and effective vaccine, but not everyone knows that they see the headlines, they get fearful of them. And the worst thing would be a push through without taking the community with you. So I think it’s quite sensible.

Read the ATAGI Statement on AstraZeneca.

One of Burnet’s leading epidemiologists Professor Mike Toole AM also spoke in support of the ATAGI advice about AstraZeneca in the media.

Professor Toole speaking on ABC RN Life Matters.

Find out more about Burnet’s COVID-19 research.

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