The chance of blood clotting is very rare

The recent announcement by the Australian Technical Advisory Group on Immunisation (Atagi) recommending that the Pfizer vaccine is preferred over the AstraZeneca vaccine for people under the age of 50 years is significant. It is critical now for the government, various departments of health, and importantly the health profession to be the voice of calm and reason by empowering the population to trust the science. Such an approach during the height of the pandemic has led Australia to be the envy of the world as the leader in managing the pandemic. The latest Atagi recommendation is based on the relative risk of a significant adverse event compared with the relative benefit of the medication. It is also there to help doctors manage patients who may come to them with symptoms following vaccination.

To put the issue into context, all drugs have risks and side effects. For many drugs, a sheet of paper is included in the box that provides the consumer with a pile of information about the medication, how it works and potential side effects. For many routinely used drugs, there is a long list of side effects which in the main are very rare. For the case of the AstraZeneca vaccine, the rare chance of blood clotting will now be added to the current list of side effects which include sore arm, headache, fever lethargy etc. As a person who is older than 50 years of age (just …) I am very happy to have the AZ vaccine as the chance of blood clotting is very rare. The good thing is, I can now look out for it.

Prof Bruce Thompson is an epidemiologist and the dean of health sciences at Swinburne University

The government needs to rebuild trust

The problems with the vaccine rollout reflect systemic problems within our health system: poor coordination across jurisdictions, in particular between the federal and state and territory governments; infighting between professional groups, including between doctors and other health professionals; the lack of a primary health care infrastructure which can support prevention and population health initiatives; a federal bureaucracy that funds most health care in Australia but has little understanding or oversight of service delivery; and a funding system which incentivises episodic and fragmented care.

These issues are not new – they cause problems every day in our health system and people with chronic and complex conditions have been raising them for years. The vaccine rollout is the first time that many in the general community have become aware of how poorly designed our health system is. Hopefully this awareness will result in long-term structural reforms to ensure our health system is better equipped to meet future health challenges. Public trust is vital to the success of the vaccine program. The government needs to urgently rebuild the trust of the Australian community by seeking advice from public health communication specialists on evidence-based approaches to effectively communicating risk and uncertainty.

Jennifer Doggett is an editor of Croakey

The messaging has been inadequate

Although many things have not gone to plan with the pandemic response which is understandable, one of the main areas where I think the federal government has underperformed during this pandemic is with its communication strategy. While the challenges they have faced have been considerable, there have been a number of occasions where the messaging coming from Canberra has been inadequate or confusing. Obviously right now we also have the additional dynamic of a federal government that is under pressure in a number of other areas which is probably spilling over into the way messaging for the pandemic response is being received.

In order to address this issue going forward, there is a need for the federal government to focus on improving its communication to all stakeholders. Communication needs to be timely, transparent, clear and without any hint of spin. There also is a need to communicate the uncertainties associated with decisions better, so that when changing evidence results in a change in strategy this does not undermine public confidence. Messaging needs to be conscious of managing expectations and not promising things that can’t be delivered. The government also needs to be willing to answer difficult questions. And finally, messaging needs to respect the public’s ability to handle nuance and complexity.

Hassan Vally is an epidemiologist and associate professor in public health at La Trobe University

Safety surveillance systems are working

Thursday evening’s announcement has caused confusion and distress among many Australians. The news of a potential link between the thrombosis (clotting) and the AstraZeneca vaccine globally has been a bump in the global vaccination programme, which was going to be a key part of “getting out of the acute phase of the pandemic”. The setback and feelings of disappointment and confusion must be acknowledged.

The good news is that safety surveillance systems around the world and in Australia are working. We are receiving near real-time information, which is critical to responding to an emergency. As more evidence becomes available, we will learn more about the vaccine-related thrombosis, which may result in further changes to our vaccine program. Large-scale vaccination programmes such as this during a global emergency are bound to experience hiccups along the way but this is not a time to waver. While the policy makers come up with plan B around which vaccines can be procured when as alternatives for the younger Australian population, it is important to remember that the AZ vaccine is still recommended for those over 50 years of age.

For those aged under 50 years, there will be many who will be concerned. While the government recommends the Pfizer vaccine for this age group, there will be people who are willing to weigh up the benefits over the risk. It will be beneficial for GPs and clinicians who are delivering vaccines to have resources available on how to advise and guide clients on making an informed decision on what the individual benefits and risks are. Doctors often have to do this with other vaccines like the yellow fever vaccine or Japanese encephalitis vaccine, but they need to be provided that information.

It’s important to remember that the overall risk from AZ vaccine is small, the blood clots are a rare but serious side effect. The AstraZeneca vaccine will have a critical role in reducing the infections, preventing deaths and allowing greater parts of the world to become protected, so it’s important that we don’t spread misinformation, follow the expert advice and use reliable resources.

Australia is still in an incredible position when it comes to Covid-19 – we are mostly disease-free and have suffered relatively lesser compared with many parts of the world, and I personally am thankful for that.

Meru Sheel is senior research fellow at the National Centre for Epidemiology and Population Health at Australian National University

This content first appear on the guardian

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