31st January 2021, Dr Chee L Khoo
A week ago we had a detailed look at all the different covid-19 vaccines that are coming to town soon and why we should have it when it becomes available. There was uncertainty then how mass vaccination with those vaccines will be rolled out when they become available in late February or early March 2021. We now have some sketchy details on how the whole programme will be roll out and I thought it would be important that you are kept abreast with developments.
Now, remember, Australia is in a very good position in terms of control of the virus. This good fortune is the result of good government, good relationship between government and the medical experts, access to funds to support those financially affected and to make universal testing widely available, most people doing the right thing for the good of the community and good luck. On total case and new case numbers are low, our mortality is low and we have good tracing ability. Our closed international borders allow us to manage what comes in from overseas.
Compared with most other countries overseas, we are in the driver’s seat and in control. Yes, vaccine will help us get out of this Covid-19 imposed new world eventually. But make no mistake, none of the vaccines out there can claim to prevent infection nor prevent transmission. It will reduce disease severity and reduce (or avoid) deaths from Covid-19 infection. It will make Covid-19 like a mild flu but you can still transmit the virus.
You must know that the roll out campaign is pretty much unprecedented. Imagine having to vaccinate 20-25 million people twice. This is probably going to take 4-6 months if not the rest of this year to accomplished. That is, if the vaccine supplies arrived as planned. With Europe and USA crying out for supplies, maintaining an uninterrupted supply for a smooth vaccine roll out is going to be very difficult. With pressure from the opposition and media, the government is likely to over promise and under deliver. Just like they did with the influenza vaccine roll out last year.
My sources close to NSW Health tells me that the roll out will occur in two phases. Phase 1 will be divided into Phase 1A targeting immediate frontline worker, workers in hotel quarantine and aircraft staff. Phase 1B will be targeting over Australians (>70 years old) and patients with medical conditions which place them at increase risk of severe Covid-19 infections although what that means is yet to be clarified. Phase 2 will be for the rest of us and is supposed to commence when Phase 1 is completed.
Phase 1A will be expected to begin in either late February (say, Feb 28, to fulfill a promise). Due to difficult storage requirements (< -70 degrees Celsius), the Pfizer vaccine will be reserved for hospital staff while the rest of the people in Phase 1A will receive the AstraZeneca/Oxford (AZO) vaccine.
Phase 1 B
Most people in the Phase 1B will receive the AZO vaccine because it is easier to deliver to the community. Now, how the government is going about rolling out the vaccine is potentially going to cause mayhem over the next 4-6 months. Instead of assisting GPs in the whole mass vaccination campaign, the government appears to be favouring private commercial enterprise as the main vaccinators. In order for GPs to be able to vaccinate patients with the Covid-19 vaccine, GPs will have to submit a 3-page Expression of Interest (EOI) and agree to terms and conditions that is not conducive to a safe and orderly campaign. If you care to read the 18 page document, it is here. This is what is required of GPs if we want to receive the Covid-19 stock in Phase 1B:
- Agree to use a National Booking System (NBS) which is a one stop online software. Anyone who wants to be vaccinated in Phase 1B is supposed to use this one stop shop to make their appointments. This NBS is supposed to work side by side the GP practice’s appointment system which means, appointments from the NBS will likely be inserted into practice software. Further, the NBS reserves the right to increase the number of vaccinations the practice has to carry out. Oh, word from the industry is NBS does not exist yet but needs to be ready in the next 4-5 weeks!
- The vaccines will, for the first time in 30 years, come in a multi-dose vial. This poses potential cross-infection risk when rapid turnover of patients occur. (Did they not learn from the cross infection saga 25 years ago in the Eastern suburbs when a surgeon infected 5 patients with HIV from a multi-use local anaesthetic bottle?)
- The practice is expected to vaccinate anyone that asked to be vaccinated which means patients unknown to the practice will turn up for vaccination without the GP knowing any medical history or allergies beforehand.
- The remuneration that is being offered by the government is based on a 5-minute consultation rate with minimal medical interaction with the patient. It is not expected that there will be time for patients to ask questions or clarify information about the vaccine. You are expected to read the terms and conditions online when you make your appointment. It is expected to be a jab and run. Yet, patients have to wait and be observed in the practice (under social distancing rules) for 15 minutes just in case there is any side effects. The remuneration for the second dose is reduced by 10% because the interaction between doctor and patient will be even less.
We have all heard about the phrase “an offer you can’t refuse” but this EOI is an offer that we cannot accept because ofquality and patient safety concerns. Thus, unless the government changes their mind, which is unlikely, the practice will not be part of the Phase 1B roll out. This means patients who are over 70 years old will have to wait for Phase 2 roll out. It is expected that Phase 1B roll out will not be completed in time (or in an orderly fashion) and Phase 2 roll out will commence before Phase 1B is completed.
We feel that if we agree to the terms and conditions of the EOI and become involved in the Phase 1B roll out, it will affect the running of the practice. Your medical care will have to compete with the rush to vaccinate everyone that turns up with an appointment with the NBS. We do not agree that there is a need to rush through this mass vaccination. A plan involving the patient’s GP in the vaccination would have been safer and more efficient. We did not take this stand lightly and have considered that a slight delay in vaccinating our older patients will not affect their health in the short or medium term. With low number of cases in Australia, being vaccinated in March or in April or May makes very little difference since all CovidSafe measures will need to be in place likely for the rest of the year anyway and rapid mass vaccination is not going to change that. Whose “urgency” are we subscribing to?
When details of where patients can have their vaccine in Phase 1B, we will be providing that information online so that you have the choice if you choose to have your vaccine delivered somewhere else.