AMA TRANSCRIPT - AMA President Dr Omar Khorshid interview with RN Breakfast re ATAGI advice changes and COVID challenges

Subject: ATAGI advice changes re AstraZeneca and COVID challenges

FRAN KELLY: Well, there's fresh advice on COVID vaccinations for people living in outbreak areas today. The advice from the Australian Technical Advisory Group on Immunisation, otherwise known as ATAGI, now says the people in outbreak areas like Sydney and particularly around areas like Fairfield, should bring forward the second dose of the AstraZeneca jab. That means instead of waiting 12 weeks, it's now recommended by ATAGI that people should get their second jab after just four to eight weeks wait.

It's also recommending people who don't have immediate access to the Pfizer vaccine to consider getting AstraZeneca. Dr Omar Khorshid, is the President of the AMA, he joins us from Perth. Omar Khorshid, welcome back to Breakfast.

OMAR KHORSHID: Morning, Fran.

FRAN KELLY: In light of this fresh advice from ATAGI, what will doctors do if patients are asked to bring forward their second AstraZeneca jab. Is that- is, is it going to be a recommendation that, yes, after four weeks give them second jab?

OMAR KHORSHID: I think doctors in Sydney will certainly be doing their best to bring forward those vaccinations for people who've been waiting longer than that minimum of four weeks, and remembering that the some have probably already waited more than eight weeks because they, they've scheduled their three-month appointment.

It will be quite disruptive for GPs because, you know, when people had their first vaccine they've often booked in for their second one three months later and everything's planned out in advance, so it does create a lot of difficulty for those practises to, to reschedule their systems and allow people who wish to bring their vaccine forward to do so - potentially even going out actively contacting people, which of course takes staff and time.

But I think GPs will be responding because they recognise that vaccination really is the way out of the pandemic and part of the solution for getting Sydney out of this crisis.

FRAN KELLY: And do you think this advice from ATAGI then really only applies to Sydney at the moment as an area that's in the grip of the- what's a hotspot area for the, for the pandemic? Or the GPs around the country, if people come to them? I mean, there'd be a lot of nervous people in Melbourne, for instance, I imagine, given what they've been through, who might want to get themselves the protection of being fully vaccinated, going to their GPs and saying, okay, ATAGI's changed their advice; I, I've done my risk analysis, I want to get my second injection after eight weeks. Will they give that? And will you be advising them to do that?

OMAR KHORSHID: Look, that's going to be a discussion between doctors and patients. At the end of the day, doctors don't tell patients what they do, they advise them and then they offer treatments where they're appropriate.

FRAN KELLY: I'm saying if someone comes and asks for it from a GP.

OMAR KHORSHID: Yeah, look, I think, I think a GP will give it serious consideration if there's a reasonable need. The problem, though, is that the shorter the duration, the less permanent immunity that seems to be associated with the early trials on AZ - only around 60 per cent effective when the dose duration was close together.

So, that's the trade-off here and that's why it's not really advice that's applicable to the rest of the country right now. It's really focused very squarely at Sydney, or perhaps the next city that's caught in a Delta outbreak.

FRAN KELLY: The outbreak in New South Wales may continue for some time. We're going to hear that today, but it will be extended. Do you think getting a second dose, but having less protection is a gamble people should take, given vaccine supplies aren't secure? That they're going to have protection, but for less protection and for shorter period of time? So, they're going to need more protection, some kind of booster later, most likely.

OMAR KHORSHID: Remember, when we're talking about these levels of effectiveness, what we're talking about is someone actually developing some symptoms from COVID - not necessarily someone getting really sick or even dying. And it's likely that with the short duration of the Pfizer will still be- sorry, the AZ will still be effective enough to prevent those really serious COVID illnesses.

That's the hope, that the data's harder to, to get. But experience, you know, around the world has been that AZ, in fact, most of the vaccines available around the world have been really effective at stopping people ending up in hospital. So, that's really the intention here. And if the trade-off is yes, a few more people get cough and cold type symptoms because their, their immunity wasn't as good, well, that's probably a trade-off we can live with to get that second dose rate up during this outbreak in Sydney.

FRAN KELLY: ATAGI now also says anyone under 60 who doesn't have access to the Pfizer vaccine - and that's a lot of people because we have a shortage of it - but lives in an out, outbreak area should get AstraZeneca. Are you going to recommend GPs give AstraZeneca to anyone who asks, even if they're under 40?

OMAR KHORSHID: So, all along we've recommended that GPs follow ATAGI advice, and ATAGI have made a minor clarification to their, their advice to make it actually more consistent with what the AMA has been saying, which is that GPs should, where a patient makes a request as long as I've given the patient the information they need to understand the risks and benefits applicable to them - and of course, part of that includes what is your risk of contracting COVID, which is obviously very different in Sydney to what it is, for instance, in Perth - but then they should offer that, offer that jab. And ATAGI's made that clearer and easier for GPs. And I think GPs will be breathing a bit of a sigh of relief today because they've been given quite clear instructions from ATAGI with some paperwork to help them have those conversations with patients.

FRAN KELLY: And so, what about clear instructions for people in Sydney at the moment with the virus raging in- it's a hotspot. Should every person who's under 40 listening to this, should they be getting the message that they should go and get an AstraZeneca vaccine if that's the only one they can get? It's better to get vaccinated now rather than wait for Pfizer?

OMAR KHORSHID: Yeah. Again, it's a judgement call, Fran, and it's one that I know is very difficult for people. It's very difficult for doctors as well.

FRAN KELLY: I think people just want some leadership. I mean, rather than going- every person going to their GP to asking, can you give a general advice that they can then discuss with their GP? Should they be saying, okay, I'm under 40, but I should get vaccinated now? AstraZeneca's on the- is the go?

OMAR KHORSHID: AstraZeneca is on the list, Fran. I think that's as far as advice goes. And there's no doubt that the Pfizer vaccine is, is preferred for this age group, but we're living in the reality that we just don't have enough of it.

Now, remembering, too, that vaccination is not the solution to the current Sydney outbreak. You're not going to get enough people vaccinated in Sydney to solve this problem. The solution to the Sydney outbreak is, unfortunately, social distancing, testing, tracing and lockdowns. And that's really where the focus has got to be now. And if they can't lockdown [indistinct], let's move on …

FRAN KELLY: [Interrupts] Sorry to interrupt. Sorry to Interrupt, Omar, but don't you have to be careful with that advice? We don't know how long this lockdown will go. Isn't it- isn't the advice that, well, vaccine might not be the immediate answer because you can't get fully vaccinated immediately, but you should immediately go and try? Is it worth saying that to people?

OMAR KHORSHID: You should go and try if there's vaccine available, and remembering that, of course, the vaccination centres will be very busy, as I think I just heard at the end of Chris Bowen's chat there.

FRAN KELLY: Yes.

OMAR KHORSHID: They're going to be very busy. There's no point standing in a queue with hundreds or thousands of other people and not getting a vaccine. So, making sure that you've actually got access to a vaccine before you go out. And yes, if you're under 40 and you're keen to vaccinated, AZ is a very good vaccine. It's available to you and now you can get your second dose within a month, which makes it pretty close Pfizer in terms of the speed. And that's been the big concern so far. If you had to wait three months, you're probably better off waiting for Pfizer. But now that you can get those two doses together, that's a viable choice to get vaccinated relatively early, for anyone under the age of 40. Remembering AZ stocks are not infinite, but we've got quite a bit of it around, and it's a good choice for people under the age of 60 in Sydney if they wish to do so.

FRAN KELLY: And speaking of stocks, we spoke yesterday with Terry Nolan, Head of Vaccine and Immunisation Research at the Doherty Institute. He said that Australia should also be extending the advice for people who get the Pfizer vaccine to extend the second dose beyond the three-week period, to make it later. That would allow more people to get access to their first dose more quickly. What do you think of that idea?

OMAR KHORSHID: Look, I think there actually are reasons for considering a longer duration of dose, but that's around efficacy and potentially duration of that immunity. But at the moment, the advice still is the current timeframes. In terms of giving someone a single dose and potentially delaying the full dose, I'm not sure that helps us in a Delta outbreak when we know that even the Pfizer vaccine is only around 30 per cent effective at preventing symptoms with a single dose, compared with over 80 per cent with those two doses. And I think that, you know, that says to me that that second dose really still is critical during this outbreak.

FRAN KELLY: It's all pretty confusing. I mean, I've lost track of the changing advice on this vaccine and the different advice from ATAGI to the AMA to others. We've now got New South Wales offering AZ to anyone over 18 who signs a consent form. This was even before the change in advice from ATAGI. Terry Nolan said, what's key here is harmonising of the advice and the rollout protocols between the states. He says it's really dangerous having this different advice. Do you agree with that?

OMAR KHORSHID: Look, I think the more we can harmonise our messages across our Federation, the better. That's just not around vaccines; it's around lockdowns, it's around border closures, you know, what we do to prevent COVID transmission. There's many areas where each state takes a different approach or state and Federal Governments take a different approach. Everyone's got an opinion during this pandemic, and I think, you know, one of the reasons for what appears to be a chaotic rollout is the incredible pressure that every player, every person, who's doing their best, and I think it's fair…

FRAN KELLY: [Interrupts] Yes.

OMAR KHORSHID: …to say, having spoken to them, that everyone involved in the Federal Government rollout, every state health department, are doing their best to rollout these vaccines, to get the public health settings right. They're trying to do the right thing, and they do find it challenging when every decision they make is critically analysed in the media every day.

FRAN KELLY: Well, I mean, yes, they might be doing their best. I'm sure they are doing their best, and people are clearly working huge hours trying to get this sorted and roll out things, and change as the advice and the requirement changes. But a big problem remains: access to enough vaccine. We just had one text from a listener saying R.E. getting the AZ second dose sooner, I'm at eight weeks. I received an unprompted text message from my medical practise saying not to phone them about rescheduling as they had no capacity to do so. So, you know, that remains a problem. And again, people are being urged to do it. They're anxious to do it, but their GP is saying, don't bother, we don't have enough AstraZeneca. So, yeah. I think it's worth some critical analysis.

OMAR KHORSHID: Yeah, so one thing I think- Yeah, and we've certainly- we're keen, where there is supply, for there to be as many options for people to get their vaccination as possible. And certainly there's more GPs out there that aren't currently vaccinating. We have said to the Government that although they're putting very rigid requirements for any GP practise involved in vaccination, perhaps that could be relaxed a little to get more practises involved right now in Sydney, particularly if there is demand for AZ. They hadn't really been pushing it because demand for AZ had seemed to be dropping off and all of a sudden it's back up again. And so mobilising some more general practitioners, giving those GPs that are involved some more vaccine, these are all things that need to be done. And, of course, we've got to get that Pfizer out as well.

FRAN KELLY: Okay. We've got to get the Pfizer in before we can get it out. Just finally, you're in Western Australia. WA has strengthened its border with New South Wales. Only travelers with extenuating circumstances will be given consideration to come home. There's no guarantee they'll be allowed into the state under the new arrangement. This decision was made by the state's Chief Health Officer. You've criticised the McGowan Government in the past for relying too heavily on closed borders. What do you think of this decision? Is it overreach? Is it ethical? What's your view?

OMAR KHORSHID: I think it is overreach and I think it's not fair to blame the Chief Health Officer. All these decisions are made by governments. They might say they make it on health advice, but they make the decisions. It's not the Chief Health Officer that makes these really important calls. And I think it's a basic right for anybody, any resident to come home. People were over, in the eastern states, for all sorts of different reasons. There'll be people who are in very low risk areas of New South Wales, where there's absolutely no COVID. There'd be very little risk for them to come home, and particularly if they come through a quarantine arrangement. And of course, the state can put in whatever it needs to protect West Australians. That's what should be done rather than blocking West Australians from coming home.

FRAN KELLY: Omar Khorshid. Thank you very much for joining us again on Breakfast.

OMAR KHORSHID: Morning, Fran. Cheers.