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  • Written by Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia
The Conversation

Australia’s vaccine rollout is in chaos. The news last night the AstraZeneca vaccine, the only one Australia has guaranteed supply of, would not be recommended for people under 50 due to safety concerns has prompted an urgent rethink of how we get vaccines into people’s arms.

Rather than the AstraZeneca vaccine being the mainstay of our vaccination effort, as planned, the preferred shot for the under 50s will now be the Pfizer vaccine. People under 50 can still choose to receive the AstraZeneca vaccine when the benefits clearly outweigh the risks, and if they have already safely had their first dose.

After the announcement I was initially concerned there wouldn’t be enough Pfizer doses for everyone that needs one. But today Prime Minister Scott Morrison announced Australia has secured an extra 20 million doses of the Pfizer vaccine, bringing the total number of doses expected to arrive in the country to 40 million.

This is enough to vaccinate 20 million people, which is more than enough to cover the around 11 million Australians aged between 18 and 50.

The prime minister said the extra 20 million would arrive in the fourth quarter of this year. Only around one million Pfizer shots are currently in the country.

This latest news follows analysis by the European Medicines Agency concluding there was a “possible link” between receiving the AstraZeneca vaccine and very rare but serious blood clots.

Read more: New setback for vaccine rollout, with AstraZeneca not advised for people under 50

This shift in focus, away from the AstraZeneca vaccine that biotech company CSL can make in Australia, to the Pfizer vaccine which has to be imported, has serious impacts on the timing of the rollout and public confidence in the AstraZeneca vaccine.

So, what can the federal government do?

Many people over 50 will now be concerned about the safety of the AstraZeneca vaccine and may be more hesitant to get vaccinated without an alternative. Therefore, the government needs to reinstate confidence and convince over 50s the AstraZeneca vaccine is safe. This will require a major effort using Australia’s best marketing brains.

The government also needs to facilitate the approval and rollout of the Novavax vaccine. Australia has a signed deal for 51 million doses of Novavax. An application for provisional approval is currently under evaluation by our drug regulator the TGA, and it’s estimated to be available within months. This would safeguard us against any further issues with the AstraZeneca vaccine, and the Novavax could eventually replace AstraZeneca because of its much higher efficacy.

Phase 3 trials are showing the Novavax shot has 96% efficacy against the original virus and 86.4% against the UK variant. By contrast, AstraZeneca’s vaccine has an efficacy somewhere between 63%, with a standard two dose schedule according to the World Health Organisation, and 76% according to phase 3 trials in the United States, Chile and Peru. Longer intervals between AstraZeneca’s doses, up to 12 weeks, seems to be linked with increased efficacy.

Although the federal government had no way of predicting these problems with the AstraZeneca vaccine, they have been too reliant on it, especially after the University of Queensland vaccine had to be abandoned last year.

Eventually, Australia may have several times our requirement for vaccines. We should think about donating vaccines to our close Pacific and Asian neighbours who have much more difficulty in purchasing vaccines.

Read more: 3 ways to vaccinate the world and make sure everyone benefits, rich and poor

Finally, Australia really must develop our own capacity to manufacture mRNA vaccines like Pfizer and Moderna — not just for SARS-CoV-2, but to future-proof us against the next pandemic.

How did we get here?

It was all going so well. Australia, along with only a handful of other countries, was the envy of the rest of the world in its response to the COVID-19 pandemic.

But Australia didn’t feel in a particular rush to roll out the vaccination program, and didn’t start vaccinating until the end of February. To date, Australia has vaccinated only around one million people, about 5% of our adult population, with their first dose.

Read more: 4 ways Australia's COVID vaccine rollout has been bungled

The rollout has nowhere near achieved the federal government’s own stated targets, with problems emerging due to interrupted supply, logistical issues, poor communication between the federal government and GPs, and a booking system that is just not working.

By contrast, some countries were very quick off the mark in their purchase and rollout of vaccines. Israel started its vaccination program in December, and has now given at least one dose of a COVID vaccine to 61% of its population, leading the world. The UK, which has been severely affected by COVID-19, also acted very quickly, and has now given at least one dose to 46% of its population.

Unfortunately, Australia’s slow and problematic vaccine rollout has somewhat taken the shine off our enviable reputation for managing COVID-19.

Read more: Vital Signs: Israel shows how to do vaccinations right. It's a race, and we're behind

Authors: Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia

Read more https://theconversation.com/australias-bungled-covid-vaccine-rollout-suffers-another-setback-heres-how-we-can-get-it-back-on-track-158656

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