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Following Scott Morrison’s surprise announcement on AstraZeneca eligibility, the government rushed to update health advice. But questions remain about hesitancy and confusion. By Karen Middleton.

The government’s ‘fine line’ on AstraZeneca

Covid-19 Taskforce Commander, Lieutenant General John Frewen
Credit: AAP Image / Lukas Coch

The federal government has intensified its push to encourage young Australians to set aside blood-clot fears and official health advice and opt for the AstraZeneca vaccine, now emphasising it through the online booking system.

The government has changed its online Covid-19 vaccine eligibility checker to suggest directly to Australians aged under 40 that they can have the increasingly unpopular vaccine.

Last week, a day after Prime Minister Scott Morrison blindsided doctors and state and territory leaders by declaring under-40s could make vaccine appointments to have AstraZeneca after consulting a doctor, the government’s booking tool was changed to push the idea.

“Access to the AstraZeneca vaccine is being expanded to adults under 40, with informed consent,” the front page of the site now says.

A new page within the site asks anyone aged over 16: “Do you want to consider the AstraZeneca vaccine?”

But for people aged 16 or 17, it says only the Pfizer vaccine is approved.

The site states clearly that there is a very low but genuine risk of experiencing clotting. It says AZ vaccine is now available to all Australians aged 18 to 59 “where the benefits are likely to outweigh the risks and an individual has made an informed decision”.

Older Australians already have access. Anyone with underlying health conditions or in front-line work was in the highest priority group, with access to Pfizer.

The site also now links to information for healthcare providers on how to advise patients who are “weighing up the potential benefits against the risk of harm”.

That information features a table listing “potential harms” – the statistical risk of experiencing blood clots for each age group – against “potential benefits” to the wider community.

The benefits are quantified by how many deaths, intensive-care admissions and hospitalisations could be prevented by one person’s decision to accept the risk and take the AZ vaccine.

The government’s official health advice is that the Pfizer vaccine is recommended for people under 60, but that younger people could have AZ if they sought medical advice first and were informed of the risks.

Australian Medical Association president Dr Omar Khorshid was unaware of the change to the online tool, or the new document for healthcare providers, until contacted by The Saturday Paper.

“I think it is, perhaps you could say, slightly worded to encourage vaccination with AstraZeneca,” Dr Khorshid said.

He said the website’s content was accurate but there still were issues. “It walks that fine line between saying that AstraZeneca is an option but not specifically recommending it – and that, in itself, is a complicated message.”  

The AMA chief is reassured that anyone under 40 contemplating having the AZ vaccine must first consult a doctor.

“[That] leads me to be very comfortable that we won’t see under-40s unwittingly have the vaccine without being aware of the risk. The simple message here is: talk to your GP.”

Parts of the new advice document for doctors are dated June 29 and parts are dated June 28.

On Monday night last week – June 28 – Morrison revealed  he had decided to provide legal immunity for general practitioners who give vaccine advice to patients.

He linked this to his surprise announcement about opening access to the AZ vaccine to people aged under 40 – something that had not been discussed with other first ministers at a national cabinet meeting that day.

This brought younger people forward in the rollout queue. While Morrison’s suggestion does not strictly contradict the official health advice, it has been taken as both permission and encouragement by some who don’t want to wait for the Pfizer shot later in the year.

The prime minister’s decision is understood to be designed to avoid having the more than 200,000 available AZ shots expire and go to waste because of older people’s hesitancy.

Since his announcement, there has been a surge in younger Australians choosing to have the AZ vaccine.

It surprised and angered premiers and chief ministers, however.

Queensland’s chief health officer, Dr Jeannette Young, said she did not want under-40s to have the AZ vaccine when it could pose a greater threat to their cohort than the virus itself.

The move came as chief health officers suggested Morrison consider dumping AZ altogether.

The Saturday Paper understands their proposal was not official advice and was not made for direct medical reasons.

They are understood to be concerned that the level of hesitancy about the AZ vaccine may make it difficult to reach vaccination levels required to reopen international borders without switching to a less controversial vaccine.

Some state leaders had previously also suggested Australia should consider ending its reliance on AZ altogether because of hesitancy.

Recent Health Department modelling suggests the government will phase out the use of AZ by October anyway, once most over-60s have been vaccinated.

Morrison is understood to have rejected the idea of moving sooner because of the message that would send to Australia’s neighbours, especially Timor-Leste, Papua New Guinea and other Pacific countries, to which Australia has promised surplus doses.

On Tuesday, Foreign Minister Marise Payne announced Australia would be sending 15 million doses of Covid-19 vaccine to the Pacific and Timor-Leste. While she did not specify which vaccine, it is expected to be AZ.

The prime minister has transferred coordination of Australia’s vaccine rollout away from the Health Department to a senior military officer, Lieutenant General John Frewen, who is holding a series of talks this week, including with the states and territories and business leaders.

Frewen said supplies of Pfizer should improve significantly by September or October, allowing less restricted access. “That is around about the time when we might be able to look at bringing more choice into the program,” he said on Tuesday.

Large businesses want to be allowed to provide vaccination in the workplace, to speed up the rollout. Australian Industry Group chief executive Innes Willox told ABC radio the government needed a less passive strategy that made it easier for people to access the vaccines.

Karen Middleton is The Saturday Paper’s chief political correspondent.