A serious hurdle stands in the way of an obvious solution for Australia’s vaccine rollout

London: Scott Morrison is scrambling to redraw his vaccine program after surprise advice to not give the AstraZeneca vaccine to millions of Australians. Unfortunately a serious hurdle stands in the way of an obvious solution.

The decision to not use the AstraZeneca jab on most Australians under 50 because of a likely link to a very small risk of blood clots is chiefly a numbers problem: more than 11.5 million people are aged between 18 and 50.

Prime Minister Scott Morrison with a vial of the Oxford-AstraZeneca vaccine in February. Credit:Getty Images

AstraZeneca was to be the workhorse of the country’s program via 50 million doses manufactured at a factory in Melbourne. Australia has contracts for 20 million Pfizer doses but that will not be enough to make up the shortfall created by Thursday’s late-night announcement.

Australia also has the rights to about 51 million Novavax doses but that vaccine is still undergoing trials in the US, has to be approved by the Therapeutic Goods Administration and won’t be rolled out until July at the earliest and possibly much later.

So where do the extra doses come from? Asking Pfizer for more supply is the clear answer, and negotiations are already underway. However don’t celebrate just yet.

Pfizer uses a different type of technology to the AstraZeneca vaccine, so it can’t be manufactured onshore. This means Australia’s rollout is now more exposed to the uncertain and unpredictable global supply chain.

Duke University researchers estimated last month that about 6.3 billion doses of all vaccine types are currently under negotiation worldwide. Pfizer is facing huge demand for the 2 billion doses it plans to manufacture by the end of 2021. It is unclear whether the American drug giant even has the capacity to offer Australia more doses. This is the toughest hurdle the government must clear.

A worker rolls a batch of AstraZeneca vaccines onto a truck at a CSL factory in Melbourne. Credit:Getty Images

Morrison and Health Minister Greg Hunt were taken aback by Thursday’s advice by the Australian Technical Advisory Group on Immunisation (ATAGI) to offer an alternative dose to AstraZeneca for under 50s. The expert panel reached the conclusion after reviewing UK data which showed 1 out of every 250,000 people given the jab might develop a rare but potentially deadly blood disorder after being vaccinated.

Concerns focus on the young because they make up most of the cases of fatal blood clots in Europe.

Professor Greg Dore, an infectious diseases expert at the University of New South Wales’ Kirby Institute, says that even if clots formed at a rate of 1 in 100,000 vaccinated people, a 20-year-old could be jabbed every month for the next 40 years and have a 99.5 per cent chance of not getting a severe clot and 99.9 per cent chance of not dying from one.

Professor David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at Cambridge University, calculates that, based on current evidence, London’s Wembley Stadium could be filled with vaccinated people in their 20s and one person in the crowd would likely develop blood clotting.

The rate of blood clots in Germany is higher than the UK, for reasons still being investigated, which has prompted authorities there to restrict AstraZeneca for anyone aged under 60.

The European Union’s regulator this week said there was a link between the vaccine and the blood clots but cleared it for use on all age groups.

The UK drug regulator said AstraZeneca should not be used on people under 30 — an outcome some in the Australian government thought ATAGI might endorse. However Morrison had no choice but to follow ATAGI’s much more cautious decision because he spent most of this year talking about how much he values vaccine safety.

So how did ATAGI come up with a 50-year threshold when the UK picked 30? In some ways, Australia has been a victim of its own success because the chances of dying from COVID-19 are currently close to zero, meaning the risk — however small — of developing severe side effects from the vaccine might outweigh the benefits of being inoculated.

In the UK, where community transmission is still fairly high, the benefits of having the vaccine for those aged 30 and above clearly outweigh the chances of getting a life-threatening blood clot.

Prime Minister Scott Morrison, with Simon Buensch, executive director of manufacturing at CSL, and Dr Brian McNamee, chairman of CSL board, holds a box of AstraZeneca vaccines at the CSL factory in Melbourne last month.Credit:NCA

British authorities were also able to restrict AstraZeneca to under-30s with less disruption to its rollout because it has more options to fill the gap. The UK has rights to seven different alternatives to AstraZeneca, and two — Pfizer and Moderna — are in use already. Up to 30 million doses of the Johnson & Johnson jab might also be available from July, which would give Downing Street three alternatives to AstraZeneca for under-30s by the middle of the year.

Australia only has Pfizer for its under-50s right now, and Novavax might potentially come to the rescue later in the year. It might try to strike a supply agreement for the Johnson & Johnson or Moderna vaccines, but will not touch others made by China and Russia.

In the meantime, the Australian public will debate whether to take what is for the extraordinarily vast majority a safe and effective vaccine that can help bring the pandemic to an end.

ATAGI has not explicitly banned AstraZeneca for under-50s, but said Pfizer should be the preferred option. Adults under the age of 50 will only be given AstraZeneca “where the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits”.

It would be a good idea to keep some perspective when calculating the risks. Based on current UK data, the chances of dying from a rare blood clot following an AstraZeneca dose stands at about 1 in a million. The risk of dying in a car crash is about 1 in 6700.

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