For much of her long career, consumer health advocate Debra Petrys has worked behind the scenes but this week she has emerged, under pressure, to defend her role in the fateful decision taken by the Australian Technical Advisory Group on Immunisation (ATAGI) in April to recommend Pfizer over AstraZeneca as the preferred vaccine for those 50 and under.
“The decision weighed heavily on me,” Petrys told Crikey. “Did I know it would create vaccine hesitancy? Yes I did. I still think it was the right decision.”
She said this even as Australia’s vaccine rollout falters badly in no small measure due to the trashing of the AstraZeneca brand.
Petrys was one of 15 members of ATAGI. In a group dominated by top-tier medical specialists, nurses and clinical experts, she alone represented the interests of the consumer on behalf of the Consumer Health Forum, the peak body for Australia’s healthcare consumers.
The consequences of its decision also appear to have been reflected in Australian Bureau of Statistics data published this week on the reasons for vaccine hesitancy among older people: 35% of those aged 50 to 69 who haven’t been vaccinated want a different vaccine, and for those over 70 the figure is 26%.
The data does not refer to AstraZeneca as the issue but it’s hard to conclude otherwise.
“It’s very well to look back in hindsight,” Petrys said. “The Delta variant wasn’t around. And you can’t go back and change what’s happened.”
Petrys can only speak because she is no longer part of ATAGI — her term expired in June. Otherwise the public only gets to hear about its deliberations through official channels or its co-chair, Professor Allen Cheng.
Petrys and Cheng have both hit back at Prime Minister Scott Morrison for pointing the finger of blame at the advisory committee. Morrison said ATAGI had been “very cautious” and that this had had “a massive impact” on the vaccine rollout.
Petrys says she’s “a little disappointed” with his comments but has been forced to defend her role because back in April Cheng nominated consumer concerns as the “tipping point” for the AstraZeneca decision. He said it came down to a realisation that the public might struggle to comprehend the risks and benefits posed by AstraZeneca.
Petrys takes issue with being fingered as the culprit: “It was very much a collective decision and it was taken after days and nights of debating the issues. Everyone has the same opportunity to have a voice.
“From my position as a consumer representative I wanted to be sure that the vaccine was safe. I felt consumers had a right to know the risks and I think we were struggling with how the Australian population would understand the information.
“There was so much information swirling around everywhere. We were looking at confidential international data that the public didn’t know about.”
Petrys stresses that ATAGI is an advisory committee and that the government ultimately makes the decision. Cheng made the same point.
Maybe. Maybe not.
Australian Medical Association president Dr Omar Khorshid tells Crikey that although it was open to the government not to accept the expert advice, in practice it was “very difficult” for a minister to reject it. Morrison’s rationale in an interview with 2GB yesterday was: “Those decisions are made independent of government, and should be. If we want a system where drug control in Australia is not run by politicians but by professional medicos, sometimes that means they’ll be very cautious in circumstances like this.”
Again, maybe. Maybe not.
“What the government could have done was go back to the ATAGI,” Khorshid said. “They could have sat down with the stakeholders and discussed the recommendations, but they didn’t. Part of the problem was the dramatic way it was done, with Scott Morrison going out and making a statement that night.”
So was ATAGI’s decision on April 8 the right one?
“I was surprised,” he said. “The problem was that the advice they supplied should have been modelled on a big outbreak. There is a question, too, if they adequately considered the community benefit.”
At the time of the decision Cheng put out a long rationale on Twitter. He set out the balancing act between the risk of dying from blood clots from AstraZeneca against the risk of dying from COVID-19 — a complicated equation taking in gender, age and the amount of COVID in the community. In the UK, where COVID was everywhere, the equation meant that AstraZeneca was recommended for anyone over 30. In Australia the threshold was now to be set at 50.
Why?
“In Australia, we don’t have COVID in the community at the moment, but we recognise that the risk of incursion is ever present,” Cheng wrote. “So the balance of the risks and benefits are different. If there was a lot of COVID about, then the benefit in preventing COVID would outweigh the risk for almost all adults, except for very young adults. This is pretty much the situation in the UK at the moment.”
Neither statement has aged well.
Cheng also made much of patients’ rights: “We also carefully used the word ‘prefer’ (Pfizer over AZ) in younger people. We respect patient autonomy — that people have a choice about the vaccines and treatments they get.
“If a younger person said that they were happy to take a one-in-200,000 risk of clotting for the benefit of getting protected from COVID earlier, then as long as this was an informed decision, we should respect that choice.”
But who would easily trust AstraZeneca after that? And all for a blood-clotting risk experts put at 0.0005%.
Chief executive of the Consumer Health Forum Leanne Wells says the forum had faith that ATAGI fully informed itself of all the data and information it needed to give its advice based on the best information at the time.
“As we’ve seen with the Delta strain, the community accepts that the pandemic is an evolving situation and that advice to consumers is likely to change,” she said.
“The issue we need to be assured about is that best efforts are being made to meet consumers’ thirst for clear, unambiguous, consistent and timely information. At present, this appears to be varied across governments and even across the medical community.”
The decision not to recommend AZ for under-60-year-olds was made on the basis of a personal risk-benefit analysis. As Dr Korshid notes in a quote in the article: “There is a question, too, if they adequately considered the community benefit”. This is an important point – every person vaccinated reduces the risk for everyone else in the community. A personal risk-benefit analysis is appropriate for therapeutics such as blood-pressure medication. I don’t believe it is appropriate for vaccines – the risk-benefit analysis should take into account the entire community.
Spot on. This idea of individual assessment and assessment of risk is unworkable, and not the basis upon which our health system works. Both ATAGI and the government should have known better.
Well said. Vaccination only works when all or most people have been vaccinated. It’s a communal concept. The situation we’ve got ourselves into is akin to ‘consumer choice’: will the individual choose to be vaccinated, and which vaccine will he or she choose?
Vaccine goldilocks
I love this vaccine “choice” Dr Cheng and you seem to think we have. We have no “choice”. We are given what the government and ATAGI decided we should have based on our age. I am allergic to AZ. I have a serious case of hives and look like a burns victim at the moment and have done so since my first dose over three and a half months ago. When I went for my second dose guess what they said could have? Another AZ dose. There is no choice possible according to the front line workers. I refused. Luckily there was a doctor who came to see my condition and decided I should have a Pfizer dose which I did without any further problems. The advice ATAGI gives in their online publication is that if there is a serious side effect from the AZ vaccine another vaccine should be offered but it seems no one informed the front line workers.
As an example of our lack of choice – the digital vaccination certificate is programmed to only accept two doses of the same vaccine. One dose each of different vaccines does not compute and therefore no certificate. It’s a work in progress…
Agreed. My motivation in getting the AZ jab was that a small personal risk was outweighed by the massive and certain ongoing damage to tens of thousands people – casual workers and small businesses smashed by lockdowns, people separated from families overseas, international students and temporary visa holders in limbo, and more. That damage is psychological and economic and likely to last for years. Unfortunately the Federal Government’s rollout communication has virtually ignored this factor in its messaging. The only time they refer to the greater communal good is when Frydenberg spruiks ‘Team Australia’ to spin some financial sop to Business Council members.
Yep – for the same reason we stop people smoking in place where others are subjected to the 2nd hand smoke. It’s about the common good. You can make your choice but dont inflict its consequences on me. Mass vaccination is always a ‘common good’ decision.
The maths is simple, and the ATAGI decision was dumb. Dumber than dumb. It should not have been based on the risk during the extremely low rates of transmission, it should have been based on what would have happened in a major outbreak. Like the one we have right now.
NSW has roughly 1/3 of the nation’s population, and in turn Sydney has roughly 1/5 of the nation’s population.
If the entire country was given AstraZeneca then regrettably 25 people would die. If more than 8 people in NSW, or more than 5 people in Sydney die during this outbreak, they’d have all been better off having had AZ. Except of course for those few who died of TTS. Four to go.
Instead we went with the new mantra of zero risk is all we can accept. And created a much bigger risk.
Interesting logic here. So the people of Sydney might be better off if they were vaccinated, but 20 people in the rest of Australia would die from AZ when they were not at threat from COVID. Maybe if quarantine workers in Sydney had been vaccinated no-one would be dying of COVD now.
It’s called community benefit. Is it better that 25 of us die of the vaccine, or a couple of thousand of us die during a COVID outbreak? It’s pretty tough on the 25 who die of TTS, but much better for all of us as a community to just say “here’s your AZ vaccine”.
And I played community benefit roulette myself. Both doses of AZ now safely in my arm.
So you only have a 30% chance of contracting the disease if exposed. Better than nothing I suppose.
And as a frontline health care worker I have a pretty high chance of being exposed. But yes, my chances of getting the disease are much reduced. And if I do get it the chances are in the 90%+ range that I will not need to be admitted to my own hospital, nor will I die, an outcome I am quite happy to avoid. Nor is it likely I will get long COVID, another outcome I’m quite happy to avoid. The chances are that if I do get it I will be pretty much assymptomatic. At worst I will stay at home with bit of a cold for fourteen days. If I do get it, it will be an inconvenience but the chances of serious sequelae are minimal. Vaccination with any of the approved vaccines reduces this disease from a killer and a maimer to a bit of a sniffle. It’s much better than nothing.
Better than nothing? No, better than a 90-100% chance of contracting covid if exposed.
Can you do the Spock hand signal that goes with “greatest good for the greatest number“?
Oh wait, that was someone else, I meant “the greed of the few outweigh the needs of the many!”.
Hang on… it’s here somewhere…
Per Allen Cheng’s explanation, the model was based on an outbreak comparable to the Victorian second wave. NSW ain’t there yet (although they appear to be trying very hard).
I don’t believe they’ll hit the incompetent heights of the Victorian gov with 800 deaths. What are they up to? Two? Only 798 to go and I certainly expect them to have a better handle on it than we had.
Let’s not forget the inconvenient fact that 600 of the 800 deaths in Victoria are the fault of Richard Colbeck. And those figures are irrelevant to this discussion. Deaths this time need to be compared to the expected 25 deaths if everyone in the country had AZ.
This is silly. In South Australia, the risk of dying of COVID is less for younger people than the risk of dying of blood clotting and much less than the risk of getting seriously ill from the peculiar blood clotting associated with the AZ vaccine. It is rational for young people not to take the AZ vaccine, especially as the risk of a major outbreak developing in SA is very slight. If a major outbreak does develop it will take time and people can suboptimally protect themselves by taking AZ and getting their second dose in a period shorter than the 12 weeks recommended for maximum protection. People can also protect themselves with masks, while the outbreak lasts, regardless of other measures that might be required.
Of course, the situation is worse in NSW and Victoria. Still, for the young, wearing masks and other measures are probably wiser that rushing to get AZ.
Even so, the AZ vaccine does not provide as good protection as Pfizer. We are in this difficult situation largely because the Coalition government has dealt with quarantine and vaccination as they did with the NBN, relying on older technology and refusing to invest in the technology for making mRNA vaccines because it was cheaper. It is remarkable that they were prepared to toss billions at businesses who had only a momentary fall in revenue but could not toss billions at making sure Australia had its own mRNA production capacity and at buying more Pfizer upfront when they had a chance to do so.
No it is not silly. It is rational, logical, and what is actually needed. The risk was lower in South Australia when there was no Delta outbreak. But there was always going to be another outbreak, so the time to act is prior to that outbreak. Which unfortunately was 5 weeks ago now.
And to be effective 80% of the entire population has to be vaccinated, because leaving the young unvaccinated just means any outbreak will continue to circulate, and they’ll pass it on to others even if they aren’t unwell. Who may very well get sick and die. The required figure for herd immunity from an infectious agent with an R0 of 5 (like Delta) is 80%
So we don’t get there and we are under the required immunity level, and the virus continues to circulate. That is a bigger risk to more people (the entire community) than the 25 people who die from TTS in a mass vaccination campaign.
And while AZ does not provide as good a level of protection from minor illness as Pfizer, like Pfizer it is in the 90%s for serious illness and death. These are almost previously unheard of levels of effectiveness from a vaccine.
Totally agree. Astra Zeneca is a second rate vaccine supplied by a third rate government. I rolled the dice and received it and fortunately didn’t develop the clotting syndrome. Unlike four healthy Australians who were given this vaccine to protect themselves and the community and who have died or the many others (numbers unknown at this stage) who have been very seriously ill but survived the clotting disorder as a result of this vaccine. The numbers of dead and seriously ill would be much worse if younger people weren’t excluded from having AZ a few months ago. There is a safer more effective vaccine available- Pfizer – but our reckless and slack government didn’t order enough so we are stuck with this dangerous roulette now until supplies of Pfizer increase.
YOu might want top see how many under 40s are in ICUs in NSW before you spruik.
Please do tell.
As of now, 3.
The AZ vaccine is just as protective as Pfizer. The little chestnut of misinformation that it isn’t has fed into vaccine hesitancy phenomena. Pfizer efficacy rate was determined pre delta variant and published then. Publisbed AZ efficacy rate was publkshed mid delta variant. Apples for apples they are effectively identical from a efficacy perspective.
Data from the UK suggests that for death and serious disease in the context of Delta both Pfizer and AZ are still in the 90%+ range. For less serious and assymptomatic disease Pfizer still performs better than AZ. More people having to stay at home with a sniffle if AZ is used is an inconvenience at worst. Yes a bit of economic dislocation due to slightly hifgher rates of sick leave, but nothing like uncontrolled spread in an unvaccinated population.
Also remember that there are several other vaccines available which the Australian authorities have not even evaluated.
Such as? Pfizer, AZ, and J&J are all approved. Moderna is going through the approval process. Sinovax and Sinopharm would appear to be not worth the bother. SputnikV will probably never seek approval here, nor is it likely to get it due to the abbreviated trials process that was used.
So far four people in Australia have died as a result of an AstraZeneca vaccination. There have been no reports of death from Pfizer anywhere in the world. The ATARI decision may have increased vaccine hesitancy (and later changing it from 50 to 60 certainly didn’t help) but the reality is that even without that announcement many were cautious. A friend of mine reported that his grandmother, who was one of the first to be vaccinated in an aged care facility, long before April, was told by the nurse that she was lucky she was getting the ‘good’ vaccine ie Pfizer. The length of time between AZ shots also mean that even if the initial rollout had proceeded as planned, many people would still have limited immunity against the Delta variant. Blaming ATARI is a convenient political excuse for a failure to take out the insurance of multiple vaccine sources last year.
And yes, I have had the AZ shot at aged 61, as has my 24 year old son, but if we had been able to access Pfizer we would now be fully vaccinated, instead of having to wait several more weeks to gain maximum immunity from AZ. And no-one can blame ATARI for that.
Actually, there have been reports of deaths following the Pfizer/BioNTech vaccine in Norway, Israel and South Korea to name a few. With the exception of fatal anaphylaxis, causality hasn’t been proven. The Norwegians categorised a number of deaths, but not a majority, as “likely” caused by the vaccine.
None of which changes the fact that all available vaccines are apparently quite safe.
I am sorry to say there have been many deaths from the Pfizer/Moderna vaccinations. Simply Google “deaths from Pfizer”.
Data from the CDC’s Vaccine Adverse Event Reporting System (VAERS) reporting database, a U.S.-based early warning system for vaccine side-effects reports that 472 people died after receiving a Moderna vaccine, while 489 died after receiving a Pfizer vaccine in the USA. This was up to March this year.
Of course, as with all vaccines including AZ, there are a host of co-morbidities involved so this data cannot be taken as meaning that the vaccines were solely responsible. The interactions are too-complex to draw a simple conclusion.
I would not hesitate to have Pfizer or Moderna vaccines but ended up with Astra Zeneca which was fine.
We’ve turned into a nation of vaccine Goldilocks.
Those figures are lobbed around by anti vaxxers, and similar data is there from the UK, and from the TGA here. It is all deaths, from any cause, after having the vaccine. So if you died in the 30 days after being vaccinated of a completely unrelated cause to the vaccine, say a motor vehicle accident, or having an ACME brand anvil dropped on your head by a cartoon coyote, then you would still be listed as a “death following the vaccine”. For the simple reason you died after the vaccine, regardless of any causality.
Yep, post hoc propter hoc fallacy.
Quite true, and adding to that, there is no comparison data because Astra Zenica is not approved for use in the USA
I think you mean ATAGI?
How would it be if the group had said nothing and there were sudenly randome deaths from AZ because people didn’t know to look for the clotting symptoms? The problem is appalling messaging from the PM, hopeless ad campaigns and the incomprehensible failure of the government to take Pfizer up on the offer 12 months ago. The real king size issue is that Pfizer is more effective in all situations after the first dose and the second dose interval is short. AZ is not very helpful against the Delta after one dose and by the time the present first shot ones are eligible for even the reduced interval second, the Berejiklian induced outbreak will have either been halted by non vaccine means or caused an absolute disaster.
One would suggest that these different narratives round Pfizer vs. AZ etc. are more to mask the fact that the federal govt. did not hedge their bets and went for AZ, while there seems to be supply and delivery issues? Then vaccine hesitancy may have been inadvertently encouraged by creating public confusion?
Some EU nations one has a choice of several vaccines EMA approved, and some not yet.
The risks of each vaccine are minimal and far outweigh the benefits but nobbled by science denialism or ignorance and sub-optimal data literacy e.g. probability and communication of.
‘far outweighed by the benefits’