Coronavirus update | Friday 09 April 2021

Last Updated: 19 Apr 2021 12:47pm

Good morning.

I have with me the Secretary of Health, Kathrine Morgan-Wicks and obviously Dr Mark Veitch.

Now our first priority has and remains the health safety and wellbeing of Tasmanians as we work our way through COVID-19. We have taken expert health and expert medical advice every step of the way and we will continue to do so.

Last night the Prime Minister announced important changes to our country's vaccine rollout after receiving update advice from its vaccine expert task force and the Australian Technical Advisory Group on Immunisation. To be clear, the medical advice the Australian government has received remains that the AstraZeneca vaccine is highly effective in preventing severe disease caused by COVID-19. There is advice that there is a very rare side effect from AstraZeneca in relation to a blood clotting syndrome that may affect between four and six people in every one million. While this is extremely rare, it is prudent to exercise caution and on that basis the recommendation is that the Pfizer vaccine be the preferred vaccine provided to adults under the age of 50 whereas the AstraZeneca vaccine remains recommended for those people over the age of 50. And just for perspective, last night the Prime Minister said that the risk of severe side effects of AstraZeneca is much lower than with common drugs such as the oral contraceptive pill, but the important thing to do, just as what has always been done with other drugs, is to ensure that we provide the community with advice as and when it comes to hand.

This vaccine will continue to play a very important role in Tasmania's vaccination rollout just as it has done in other places around the world. In the United Kingdom alone, the advice is that some 6 000 lives have been saved by this vaccine so the benefits are very clear. And from UK data, the risk of developing this very rare blood clotting disease following the vaccine is about five per one million people.

As I said last night when we received this advice, our Tasmanian health authorities contacted Tasmanians under the age of 50 who have a vaccine appointment booked today at our state based clinics to reschedule appointments. A communication by a GP fax-stream was also sent to all of the state's GPs overnight. An updated advice is also being uploaded to the website. Further contact will be made with people under 50 today who are already booked in for their vaccination and also under 50s who have already received their first dose of the AstraZeneca vaccine. Staff working at the clinics also have this updated advice in case Tasmanians under the age of 50 turn up for their vaccine and are unaware of the change.

In making this change last night, Australia's Chief Medical Officer outlined that of an estimated one million doses of the vaccine administered in Australia so far of both AstraZeneca and Pfizer, there has been just one case of this rare clotting disorder. However, those who've had the vaccine within the past two weeks should be watching out for specific symptoms which both Kathrine Morgan-Wicks and Dr Veitch will provide more specific advice on in a moment.

In terms of what this change means for Tasmania's planned vaccine rollout, we are working our way through that and as the Prime Minister said last night, there will be some recalibration, but we will work our way through that over the coming days. We will continue to vaccinate our high priority frontline workers with the Pfizer vaccine and our state-based clinics are primarily vaccinating those in the over 70 cohort with the AstraZeneca vaccine.

We will review our program and timeframes based on requiring more of the Pfizer vaccine which is dependent on its supply into the country and obviously into the state.

Before handing over to Kathrine Morgan-Wicks and Dr Veitch, I’d like to remind Tasmanians and if they have any concerns they should please ring the Public Health Hotline on 1-800-671-738 or contact their GP.

I’ll now hand over to Kath to make some further comments.

Thank you, Premier.

Based on the latest information available, the Australian government has advised that the AstraZeneca vaccine remains a safe and effective vaccine in most cases. However, due to a low number of adverse reactions that have been reported, it is now recommended that Pfizer will be the preferred vaccination for people aged under 50 and we are adjusting our Tasmanian vaccination rollout accordingly.

Since receiving the ATAGI advice yesterday, our Tasmanian Vaccination Emergency Operations Centre has worked through the night to make sure that all vaccinations continue to be safely administered in Tasmania.

With the ongoing global threat of COVID-19 it is critical that Tasmania's vaccination program continues, but that we do so safely. Following the advice that is provided by our key medical technical advisory groups, Tasmania is now into the seventh week of its vaccination rollout and state vaccination clinics remain open today and will continue to administer both Pfizer and AstraZeneca vaccinations. GPs and GP respiratory clinics are also continuing today to administer AstraZeneca vaccines, but will do so in accordance with ATAGI’s latest advice.

To put this into context, to date we have delivered twenty one thousand four hundred and seventy five doses in state clinics these are made up of sixteen thousand and forty eight doses of Pfizer and five thousand four hundred and twenty seven doses of AstraZeneca. Up to 7 April the commonwealth has delivered 5 083 doses in residential aged and disability care and GP clinics have delivered 12 278 doses in Tasmania. That is a total of 38 836 doses delivered in Tasmania with just over 5.3 per cent of the population receiving a first dose. Since the first dose of AstraZeneca was delivered in Tasmania on 9 March more than 17 700 AstraZeneca doses have been administered and more than 90 per cent of these doses have been administered to people aged over 50 years. We estimate that 1 424 people aged between 18 and 50 have received a first dose of AstraZeneca in Tasmania.

The Department of Health is in the process of contacting everyone in this group to ensure that they are aware of the latest ATAGI advice noting that these adverse reactions are extremely rare events with a rate varying from four to six cases per million doses of vaccine given. Additionally it is important to note that adverse reactions have only occurred within a small time period of between four to twenty days and only after the first dose. Although the incidence of these reactions is very rare, it is very important to be aware of them and to seek medical advice advising your doctor that you have received a dose of AstraZeneca vaccine if you experience any of the following symptoms after your vaccination: neurological symptoms such as severe and persistent headaches or blurred vision, chest pain, leg swelling, persistent abdominal or belly pain, shortness of breath or tiny blood spots under the skin beyond the site of the injection. If you received your AstraZeneca vaccination more than 20 days ago and have not experienced any adverse reaction, at this stage a reaction now is very unlikely. Based on this the advice remains that it is safe to receive your second dose of AstraZeneca vaccine when it is scheduled. Importantly for the over 50 year age group, and we have around 8 million Australians falling into this category, the current advice is that the AstraZeneca vaccine remains safe for use and GPs and state community clinics will continue to vaccinate this group when it is their turn.

Tasmania will work with the commonwealth to continue administering Pfizer vaccines to our phase 1a group and we'll prioritise our remaining Pfizer doses to our under 50s that are due to receive a first dose in phase 1a or 1b.

A lot of work will need to be done over coming days to factor in recalibrated vaccine volumes and schedules from the commonwealth and to reschedule any under 50s that have already made a booking with one of our state community clinics.

If you are under 50 and already have an appointment with your GP, they'll be in contact with you and will arrange an appointment for you to receive a Pfizer vaccine in a state clinic. I ask once again for everyone's patience while we work through this as quickly as we can and will be regularly updating our information on our coronavirus website as soon as it is to hand. And if you have any urgent concerns, please do contact our Public Health Hotline on 1-800-671-738 or for medical advice please talk to your GP or to your health care provider.

I’ll now hand to Dr Mark Veitch who can answer questions in relation to the ATAGI advice and the rare adverse events and then I can return for questions on the rollout. Thank you.

Thank you very much, Secretary.

I might just make a few preliminary comments to provide a little bit of background that may actually answer some of the questions you have.

A few months ago before we had the vaccines available and in use, I spent a bit of time explaining how vaccinations are evaluated before they're licensed for use widely in countries. And I explained how there are studies done first on small numbers of people; then thousands of people; then tens of thousands of people; looking at how well the vaccine works and how common are side effects with the vaccines. What I also said at the time was that once you've done these phase 1, phase 2, phase 3 studies, you have a lot of information and it's often possible to license a vaccine for an important and urgent use if it's got a good safety profile from these trials and it has evidence that it actually works to prevent severe illness -and that's what's occurred with both of the vaccines in use. But the point that I also made that I’ll make again today which is very important is that rare side effects may not be picked up in vaccine trials of 5, 10 or even 50 000 people. If that side effect only occurs once every 200 or 250 000 doses and that's what's occurred in this occasion and that's why it's important that we've had post-marketing surveillance.

We've had surveillance that's been conducted in Australia; surveillance that's been conducted in the European countries particularly those that have used AstraZeneca vaccine and that's been able to pick up these side effects that are so rare that you don't pick them up in the initial trials. So we know now with around about 20 million doses of AstraZeneca vaccine distributed in Britain they've had around 80 cases of this thrombosis with thrombocytopenia syndrome so that's where the one in every 250 000 or so doses comes from or the four to six per million. So that was picked up through surveillance in the UK and our own agencies in Australia are doing surveillance for adverse events and that's why we've managed to pick up a single case of this condition in Victoria - a probable case of this condition in Victoria - but none in Tasmania or elsewhere in Australia to date. And it shows that the surveillance system for adverse events is working and it provides us with information that enables us to adjust the advice to people receiving vaccines adjust our vaccination programs and continue with the vaccination programs safely while reducing the risk to the people who may be at greater risk of getting these side effects.

The understanding of this condition is evolving and it appears to be an immune response to part of the vaccine. We'll learn more about that in the weeks and months to come. As I said it's exclusively associated with the first dose of the AstroZeneca vaccine and there have been no occurrences of this syndrome in two million dose second doses of the vaccine in Great Britain so i think that gives people confidence that if they've had their first dose, as I have, that we can receive a second dose without concern about the risk of this severe side effect.

It's also important to say that there's been none of this side effect associated with the Pfizer vaccine. The incidence of this side effect does seem to be higher in younger age groups and that's one of the principal reason why a decision has been made to restrict the use of AstraZeneca vaccine and to preferentially use the Pfizer vaccine in people aged under 50 because that way we're reducing the exposure of that perhaps more vulnerable group to this side effect when there's another vaccine available for them to use.

The other consideration is that as well as appearing to be less likely to get the side effect from the AstraZeneca vaccine, older people are also much more vulnerable to the consequences of coronavirus infection and we're living in a world where coronavirus is still circulating where an outbreak could occur any day in any part of Australia which is moving and mixing so freely. So it's extremely important that we do progress to protect those people most vulnerable to severe consequences of COVID vaccine by proceeding with the AstraZeneca vaccine in those people who are eligible and aged over 50.

There'll also be considerable material that's been produced by the commonwealth for providers for the public and as part of the consent process to make sure that people understand the risks and benefits of the vaccine and since last weekend in fact there have been changes through the consent forms to draw attention to the rare occurrence of this thrombosis thrombocytopenia side effect. Kath ran through some of the side effects that people can have if they do get this rare clotting syndrome.

I’d like to remind people it's important they keep them in mind if they've had the AstraZeneca vaccine and in the, you know, four to four days for about a fortnight after that they consider do they have an unusually severe headache, chest pains, neurological symptoms such as blurred vision, swelling in their limbs or abdominal pain or any unusual bleeding or bruising in their skin. However I’d also remind people who have any side effect not specific not even specifically those side effects any unusual symptoms in the days after any vaccine, that it's important to get medical care. It may be due to a vaccine but it could also be another medical condition that's occurring coincidentally in the aftermath of the vaccine so do come forward and seek help if you have symptoms.

So I think I’ll just end by reiterating that the vaccine is, all the vaccines including the AstraZeneca vaccine, are well tolerated by people generally with only mild side effects. It's common to get a sore arm or feel a bit achy occasionally; a mild headache and a bit tired for one or two days after the vaccine but side effects that prevent people from going to work or conducting their normal activities are uncommon and we have a reporting system to capture those and evaluate them.

We're going to face coronavirus in our midst eventually and it's absolutely crucial that we proceed with the vaccination program.

As you heard there's going to be a little bit of reconfiguration of the vaccines and the programs over the coming days it's a long stretch that we're going to be involved in this. It's going to be many months but we do need to stick with it and the public needs to seek all the information that they need to give them confidence that the vaccine is safe and effective.

I’ve had my first AstraZeneca vaccine, I’m a shade over 50, but I have some conditions that make it me a little bit more prone to getting severe COVID and I’m certainly looking forward to getting my second vaccine in about a month and the knowledge that's going to give me firm protection should COVID start to circulate in Tasmania or elsewhere later this year or at some stage in the future.

Do you expect that this will slow down the rollout in Tasmania at all? It must slow down the rollout in the short term, but the really important thing is that we get the reconfigured rollout right so we get the planning to be able to get the right vaccine to the right people. Obviously we can't get the vaccine to everybody at once, so it does require asking people to be patient and to understand that it's going to take i imagine the better part of this year and perhaps even sometime into next year until we've got the whole of the Tasmanian the Australian population vaccinated. I hope we can do it; I hope we can be one of the first states.

You've just given a very comprehensive briefing - very complex - but what would your message be to people out there who might use what's happened in the past 24 hours in an anti-vaccination argument? I would draw their attention to the fact that this information of the last 24 hours is being frank with the public and honest with the public and explaining to them that there's been identified a rare risk associated with the vaccine. Keep it in context; one in every roughly quarter of a million doses. It's a serious side effect, so we have to do what we can to reduce the likelihood of that occurring. That's why we're restricting the section of the population that's getting this vaccine so I would ask them to compare that with the experience of countries like the the UK, Italy the US where people may have friends or family and see what happens when you have an unmitigated outbreak of coronavirus in your midst. It's clear the consequences of that is much more grave than a very rare side effect that we're sharing with people and adjusting the program to avoid.

Just how serious is that? It is a very serious blood clotting effect - a blood clotting disease - it's quite different from common organ clots in the leg - common garden clots - in the leg that some people get. Some people get it from the pill, some people get it from surgery, some people from being in a confined place for too long. They're called deep venous thrombosis. They're quite common. There's probably 500 of those a year in Tasmania that are managed quite uneventfully. This is a much more severe disease that can cause clots in parts of the brain clots in the blood vessels in the guts and it can actually cause death in about 25 of people, so it certainly is a severe consequence and that's why it's important that people are aware of it but if you think it through that risk of death is probably in the range of one in a million in recipients of doses. If you, you know, one in 250 000 people gets the vaccine and gets the complication and a quarter of them die, that's a one in a million risk of death. However, people who do get this thrombosis thrombocytopenia syndrome can have long-term consequences because of the damaged organs that the clots can do.

Just to clarify: what will happen now with people under 50 that have received their first AstraZeneca jab? They'll get a second jab still. So we'll be contacting everyone that has received an AstraZeneca vaccine in our state community clinics and we'll be reassuring them as to making sure they're aware of the ATAGI advice that's been delivered last night and letting them know about the symptoms and just to be to be aware. So they're all getting contacted. We're also speaking to all of our GPs that are providing the vaccine to similarly make that contact with patients. But I mean the advice though is that they can still proceed to that second absolutely. So for everyone that hasn't experienced any of these symptoms, and just to be aware of them, and the very risk of that occurring. But for everyone else, the advice from ATAGI is very clear: if you haven't experienced those that a second dose is absolutely safe and appropriate.

So there's really no need to panic in this? Just stay informed is what you're saying? That's right. So in terms of this event, and as Dr Veitch has outlined, this is the reason why we have these safety monitoring and processes. It's critically important that we share the information as we receive it from ATAGI and to reassure our Tasmanian population that the vaccination program is continuing. We are continuing to vaccinate with our clinics open today.

I appreciate that the Prime Minister's announcement was only a little bit after seven last night, but what sort of delay are you anticipating to the vaccination program here because i think the whole nation was looking at an October - I think October deadline? What where do you think we'll end up at now? So we'll be meeting with the Commonwealth again this afternoon and working through their recalibration of the vaccine delivery. So they are looking at all of their shipments and distribution volumes to each of the states and territories and we'll be providing us with more information this afternoon. So we'll have more information coming out in coming days.

I know you said that most of the vaccinations we've delivered so far have been the Pfizer ones, but given that the given that AstraZeneca is the one that we're making in Australia at the moment, you can you see that there will be a delay given that that's the one that we're manufacturing locally? So we're predominantly, so we're in the phase 1a and 1b cohort and which is predominantly in 1b the over 70s and that absolutely should be continuing unabated. So in terms of the under 50s which come in primarily into a later phase, so into phase two that's where we need to make sure that our vaccine volumes are going to line up with our distribution ballpark figure.

How many appointments have had to be rescheduled? So today in coming weeks given that under 50s now can't receive their vaccinations so we have contacted around 35 or 36 people that were actually booked in who are aged under 50 into a state clinic today. I can't give you the numbers in terms of GPs but we've certainly made sure that all of the GPs have the information and we'll work through the bookings which we've got you know out several weeks and make sure that everyone receives a call or the information about the ATAGI advice.

What happens if you contact someone who's received their first dose and you're assuring them it's okay for them to get the second one - what happens if they say ‘oh, I’m a bit concerned based on the most recent advice’? What if they don't want to get their second dose? What happens? So importantly with any vaccine it is about informed consent so we need to be absolutely critically sure that people are providing informed consent to any vaccine that's occurring. The commonwealth are updating and we updated last weekend in terms of the inclusion of this rare risk of this event and further information would be provided in the consent forms for everyone today; for every individual to make that decision. But certainly in terms of the age groups, ATAGI has, you know, played its role in terms of providing the advice and recommending that for under 50s the preferred vaccine is Pfizer.

So it's now going to be a question of securing more Pfizer vaccines; is that the correct assumption? So the commonwealth already has secured some 20 million doses of Pfizer and certainly in terms of the types of vaccines that are available in Australia the commonwealth is working through that.

So do you anticipate that we'll be using more Pfizer in Tasmania now? I’m sorry, I’m still just trying to wrap my head around this a little bit? So in terms of actually the next week - so weeks seven to twelve - and the state was actually receiving more doses of Pfizer than AstraZeneca in the rollout so we will go back and look at all of our scheduling, all of the distribution of our vaccines and also work through whatever information comes through from the commonwealth today.

Given that going back to that classic thing about Pfizer at the temperature that it's got to be stored at, given that if we're going to be using more of it, is that going to be a logistical issue that authorities are now going to have to solve? So we have three Pfizer clinics that are currently operating in Tasmania. So at our Royal Hobart Hospital, Launceston General Hospital and also our North West Regional Hospital. And those clinics have now been operating for some seven weeks and certainly our logistics has really sped up in terms of the operation and the ease of operation of those clinics. So we are pumping through - some 480, for example, went through our Royal clinic yesterday. So we'll work through the numbers and I’m sure that we can match the volume of vaccine that we receive to getting into the arms of Tasmanian people.