Australia Rise in rare clotting cases drove ‘difficult' call on AstraZeneca vaccine
NSW woman's blood clot death linked to AstraZeneca vaccine
A woman in New South Wales has died of a rare blood clotting disease after receiving the COVID-19 vaccine, the Therapeutic Goods Association has reported.A woman in New South Wales has died of a rare blood clotting condition after receiving the AstraZeneca COVID-19 vaccine, the Therapeutic Goods Administration has reported.
The federal Health Minister's top immunisation advisers say the decision to limit the AstraZeneca vaccine to over-60s was made because of the concerning number and severity of non-fatal cases of a blood clotting condition in people in their 50s and came after weeks of difficult deliberations.
Experts on the Australian Technical Advisory Group on Immunisation told The Age that the move to change the clinical advice, another major disruption to the nation's lagging vaccine rollout, came after analysing months of local and international data.
How are blood clots associated with the AstraZeneca vaccine detected and treated?
Experts say we can now quickly detect and treat rare blood clots linked with the AstraZeneca vaccine. This is what is involved.The blood clotting condition was likely linked to the AstraZeneca COVID-19 vaccine, according to the Therapeutic Goods Administration (TGA).
The group's co-chair, Professor Christopher Blyth, said the expert advisory group had felt compelled to make the difficult call following weeks of "robust debate" among committee members.
"This was not a small or whimsical decision, it was very hard," the paediatric infectious diseases specialist said.
"There is significantly more than deaths to talk about. We've got some people who have had significant medical complications from this and so that's why we need to have a program which is balanced."
Although the rate of deaths due to the rare complication called thrombosis (blood clots) with thrombocytopenia (low platelets) could even be lower than had been forecast, multiple ATAGI members who spoke to The Age said they had become increasingly concerned by the number and severity of the non-fatal cases that were being reported in people in their 50s.
Awkward! Differences in English that are good to know
Awkward! Differences in English that are good to know
The head of the National Centre for Immunisation Research and Surveillance, Kristine Macartney, who has been a member of the group for almost 20 years, said they also calculated the probable number of future cases in those aged 50 to 59, and were uncomfortable with what that revealed.
Professor Macartney said it was initially thought that the rate of thrombosis with thrombocytopenia was about 1 in every 100,000 or 1 in every 200,000 for those in their 50s.
"But over time the rate has just steadily climbed. It's now more like one in 35,000 or 40,000," she said.
Professor Macartney said while she wanted to provide assurance to anyone who had recently got an AstraZeneca vaccine that it was still a rare condition, "it also becomes more apparent in the 50 to 59 age group that the cases had tended to be a bit more severe, with clots in both the brain and/or the abdominal blood vessels".
Coronavirus vaccine advice on AstraZeneca has changed again — here's what it means for under-60s
Why have the risks of AstraZeneca changed, why is clotting more common in younger people, and what should you do if you've already had the vaccine?The Australian government says the new advice balances the risk of developing a rare blood clotting condition after getting the vaccine against the effects of COVID-19.
Doctors are still strongly urging those who have received their first AstraZeneca to go back for their second dose.
Chief Medical Officer Professor Paul Kelly said anyone who had a first dose of AstraZeneca without a problem "should feel very confident to have their second dose, and they should keep that booking."
Data from Britain shows the rare clotting syndrome
Two Australian women, aged 48 and 52, have died from the clotting disorder after receiving the AstraZeneca shot and four million doses of the vaccine have been administered nationwide.
A 52-year-old NSW woman died last week, with the Therapeutic Goods Administration saying she died from a clot in her brain. In April, 48-year-old Genene Norris, also from NSW, died from blood clots likely to be linked to the vaccine.
However, the risk of thrombosis with thrombocytopenia is lower in older groups, with 1.4 cases in every 100,000 AstraZeneca vaccine doses reported for those in their 60s compared with a rate of 2.7 per 100,000 doses in the 50 to 59 age group.
AstraZeneca and EU both claim victory in vaccine battle
AstraZeneca ordered to deliver 80.2 million vaccine doses to EU by Sept 27, but EU wanted 120 million by end of June.The court ordered AstraZeneca to deliver a total of 80.2 million doses to the EU from the time the contract was agreed up until September 27. The ruling said the company did not appear to have made a “best reasonable effort” to meet the delivery schedule because it had not used its United Kingdom production sites.
Murdoch Children's Research Institute vaccine uptake expert Margie Danchin is a non-voting member of ATAGI and said it would be unwise for people aged 60 or over to put off having a vaccine until later in the year as they waited for an alternative to AstraZeneca.
"The last thing we want to do is have a massive outbreak and people turn around and say ‘you said wait and now people are dying from COVID disease'," she said. "That would be an absolute tragedy."
Melbourne consultant engineer Barry Clearwater, 67, has already had one shot of the AstraZeneca vaccine and sees it as his duty to get his second jab when it's due in August.
"I think we not only have a duty for ourselves … but also a duty to others, [so that others are] able to have an income, such as waiters, chefs and travel people, and we need to get going again," Mr Clearwater said.
While federal health authorities have conceded Thursday's decision will temporarily slow the vaccine rollout as people in their 50s reschedule their first doses, Health Minister Greg Hunt said the call by ATAGI could actually increase uptake overall, as those in their 50s hesitant to get the AstraZeneca vaccine take up the Pfizer jab.
Fears AstraZeneca reputation has been ‘tarnished' beyond repair
Vaccine experts say the negative public sentiment is unfair, and the AstraZeneca jab could be the key to avoiding death and serious illness in Australia this year.Vaccination experts say they fear the reputation of the AstraZeneca vaccine could have been tarnished beyond repair in Australia, leaving the population dangerously exposed to coronavirus outbreaks in the months to come.
"What this will do is it will mean, for those potentially up to a million people who were AstraZeneca-hesitant within that age group, they will have access to Pfizer," Mr Hunt said.
Asked how the change in clinical guidance would further slow down the vaccine rollout already beset with delays, Dr Blyth said increasing reliance on Pfizer vaccines would mean "supply will again be challenged" for the next few months.
But he was hopeful constraints on supply would eased later in the year with tens of millions of doses of Pfizer and Moderna vaccines expected to arrive in Australia.
He said a number of mitigation strategies to increase vaccination uptake in Australia were being actively considered by the expert panel.
This included the possibility of widely distributing first doses of the Pfizer vaccine, and delaying the second dose, a strategy that had been used overseas to increase partial protection and immunity quicker.
"All of those things need to be considered in light of this decision, and we're looking hard at that at the moment," he said.
Associate Professor Danchin said experts on the group agonised over the decision to change the preferred vaccine for those in their 50s, concerned about the impact it would have on public confidence.
"It was becoming painfully clear that the severity in that age group, the 50 to 59-year-olds, was unacceptable," she said.
Those aged under 60 are more likely to get severe side effects, with 33 per cent requiring an admission to ICU, compared to 15 per cent for those 60 and over.
"We shouldn't just be talking about two deaths," said Associate Professor Danchin. "We're talking about an increase in severity which is unacceptable in terms of long term complications for some of these people."
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GPs fear AstraZeneca vaccines could go to waste .
While many patients who had already received their first dose of the vaccine are returning for their second, demand for first doses has taken a blow.Doctors say leftover supplies of the AstraZeneca vaccine could expire in the over-stocked fridges of medical clinics due to falling demand, wasting scarce global resources.