Australian Medical Association says NSW Covid lockdown failing and urges change to AstraZeneca advice

The president of the Australian Medical Association, Dr Omar Khorshid, says it is unlikely lockdown measures can contain the Delta outbreak in New South Wales and has urged the Australian Technical Advisory Group on Immunisation (Atagi) to recommend the AstraZeneca vaccine for more age groups.

Currently, the Atagi advice recommends the Pfizer vaccine, which is in short supply and high demand in Australia, “as the preferred vaccine for those aged 16 to under 60 years” due to the risk of rare but severe clotting known as TTS linked to AstraZeneca and more frequent in the under-60 age group.

Khorshid said that advice must be changed given the growing number of infections in NSW, with a concerning number of people still in the community, including in workplaces and supermarkets, while infectious. During her daily update on Friday, the NSW premier, Gladys Berejiklian, said vaccination would now be key to containing the outbreak and getting out of lockdown.

“The problem is we don’t have supply,” Khorshid said. “In my view we need to revisit the recommendation for AstraZeneca around young Australians because, at the moment, that is the vaccine that is most available. But we can’t get that into arms more quickly if people are not willing to have it.

“And the problem has been they will not have it. So I think we need a revision of that Atagi advice and later today I will be calling on Atagi to change its advice, which at the moment asks individuals under 60 to make their own risk assessment about whether or not to have it, which really isn’t suitable for the NSW crisis in the middle of a pandemic.

“If Atagi agree with the AMA – and they are the experts – that the situation in NSW is not getting better but worse, and given vaccination is now the strategy to get NSW out of this lockdown, then we need more to access the AstraZeneca vaccine, given we do not have enough Pfizer.”

In July, Atagi issued advice on the use of Covid-19 vaccines in an outbreak setting in light of the Sydney outbreak. The advice states when there is an outbreak and the supply of Pfizer is limited, people under 60 without immediate access to Pfizer should “reassess the benefits to them and their contacts from being vaccinated with Covid-19 vaccine AstraZeneca, versus the rare risk of a serious side-effect”.

But Khorshid said the advice was not adequate because it still put too much onus on individuals to make their own risk assessment. He said people wanted clearer recommendations from the experts during a crisis, and given the negative publicity around AstraZeneca and rare clotting.

“What we are hearing on the ground is the people are not lining up in NSW for the vaccine despite the Atagi advice,” Khorshid said. “[Health minister] Brad Hazzard said it clearly yesterday; just 50 people had turned up to one mass vaccination centre in one day for AstraZeneca, while 9,000 got Pfizer. So the demand for AstraZeneca isn’t there. And part of that is because it’s not a recommendation for a large portion of the population at the moment and if we can change that recommendation then hopefully more people will line up for the vaccine.”

Earlier in the week the co-chair of Atagi, Prof Chris Blyth, told Guardian Australia that Atagi met and discussed the latest evidence weekly. At the most recent meeting on Wednesday, there was no change to the advice.

Khorshid said he wanted to be clear that lockdown measures must remain in place in NSW until Delta is quashed.

“Today we saw a large number of new cases in this outbreak in NSW despite the lockdown settings, and that is a sign that perhaps that lockdown settings alone do not work once Delta gets out to this level into the community,” Khorshid said.

“It’s shown that, even with severe restrictions, it’s still spreading and increasing. You can only imagine what the numbers would be if Sydney was not in lockdown. So while we might need to move to a new strategy, that new strategy in the short term at least is not going to include relaxing restrictions, because that will be dangerous in an unvaccinated population, so it means ongoing lockdown. Rapid vaccination though is actually really difficult. One of the things you’ve got to avoid is spreading the virus through people lining up for that vaccine. So, it’s not going to be simple.”

He said while there was a good argument for directing vaccines away from other jurisdictions to NSW given the crisis, he could understand concern from leaders in the states and territories that a Delta outbreak could occur at anytime and therefore, they were reluctant to be left with lower supply.

“Victoria locked down much quicker than NSW and yet even Victoria is not out of danger yet,” he said. “It may be this virus is faster than our settings are. We need to join the rest of the world in rolling vaccines out as fast as we can.”

Guardian Australia contacted the Atagi co-chairs for comment, but they on Friday appeared before the Senate Covid committee.

On Friday the NSW chief health officer Dr Kerry Chant said it was younger people who were especially at risk, because they often worked in essential industries such as the food supply chain that continue to operate through lockdowns. But many are not yet eligible for vaccination. She urged the national cabinet to consider the NSW situation as a national emergency and allocate resources, including vaccines, accordingly.

“I am arguing that we need to use Pfizer for those young people to stem the transmission chain because we know that that will provide individual benefit to them and prevent them also from spreading it on,” Chant said. “What we are seeing is people are bringing it into their household and then infecting their older relatives.”

An immunisation expert from the University of Sydney, Prof Julie Leask, said she could understand the proposal to redirect vaccines towards NSW.

“But what happens then in other states where there may be an outbreak like the Victorian outbreak?” she said.

“It’s something that has to be considered … Our strategies are like staring into the sky and looking at the stars which reflect what happened light years ago. We need to make sure whatever we do now, has to have a meaningful impact on what the future outbreak risks look like.”

Leask said it was important to emphasise that AstraZeneca is an option for many people.

“And vaccine hesitancy is part of the issue with uptake of AstraZeneca, but so is confusion and inconvenience,” she said. “It’s also about not knowing where and how to get a vaccine, being turned away from a GP who doesn’t want to give it to you if you’re under a certain age, and not being able to get it from a state hub necessarily.

“Once you put barriers in the process, people try to access it but will then give up.”

But Leask said of Atagi it was not helpful for politicians or peak bodies to be questioning their advice. Some people had not even read their updated advice for outbreak settings, she said.

The advice states people in an outbreak situation who received their first dose of Covid-19 Vaccine AstraZeneca more than four weeks ago should contact their vaccine provider to arrange their second dose as soon as possible. In non-outbreak settings, the preferred interval between doses AstraZeneca remains at 12 weeks.

“The Atagi advice is well ahead of this outbreak and there is this impression out there that they are not ahead of it, which is not helped by the prime minister’s comments in recent days,” Leask said.

But their advice needed to be communicated well, and reach diverse groups, she said.

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