(Image: BBC)

Being a health worker in this vaccine rollout feels identical to working in The Office with David Brent. I’ve long since cycled through denial and anger and now all I can muster is an exasperated look to an imaginary camera, dying a little bit inside with each new development.

The vaccine fridge in 2021 has been a living monument to failure, full of flu vaccine that is rapidly disseminated nationwide year on year, AstraZeneca conspicuously absent, a casualty of reinventing the wheel on vaccine delivery.

On Monday Prime Minister Scott Morrison announced AZ could be given to anyone over 16 by their GP. This followed no consultation with GPs and now we are trying to find out if this was a new policy or a thought bubble akin to wondering aloud if we’ve looked into the option of injecting bleach.

There is ample demand for AZ among younger Australians — despite the well-publicised risks — and meeting that demand would undoubtedly be a good outcome, but it is likely there will be adverse outcomes.

It has been very difficult these past months to digest generalised vaccination advice and deliver it to people in an individualised way. More difficult when the advice changes weekly and what I told people in one half of the month becomes redundant or false later that same month. This would never happen with diphtheria or tetanus.

But that’s understandable. The risk/benefit arithmetic for the established, “old money” diseases is static, however when responding to new information about a new disease or new vaccination the risk/benefit equation becomes dynamic. Now that the risk of infection is greater, so is the benefit of vaccination despite the risks of vaccination remaining unchanged. I gratefully received my second AstraZeneca vaccine last week.

Apart from immediate vaccine reactions, the most pertinent and discussed risk associated with AZ is thrombosis with thrombocytopenia syndrome (TTS). Current data suggest this occurs at a rate of two in 100,000 for the first dose, decreasing to 1.5 in 1,000,000 for the second. In Australia two people have died from TTS with more than 4 million doses delivered.

Appropriately, TTS is described as rare. If measured against the vaccination risk/benefit paradigm of 2019 (or even two weeks ago), the consensus leaned towards even a “rare” adverse event being unacceptable. Now we have an outbreak and “rare” looks like a good deal.

Unless someone has been living under a soundproof rock with no wi-fi it is very likely they have heard that TTS is a risk of the AZ vaccine and that it is not preferred for people under 60. And since it is the responsibility of individuals to arrange their own vaccine, most GPs will understand that a person under 60 showing up for AZ is reasonably informed. Add an individualised discussion, establish informed consent and we can proceed with the vaccination.

Statistically there will be more cases of TTS and possibly more deaths. The part of the plan yet to be established is what happens to the doctors giving an AZ vaccine to someone for whom it is not “preferred” who go on to have a serious adverse outcome.

The government has provided “assurance” that GPs will be indemnified in this situation but has yet to provide any detail of how exactly that indemnity system will work. Doctors are indemnified by private insurers at their own expense, however that system is not equipped to cope with the new risk paradigm.

In any given consultation the question of “what action should I take” is echoed by its weaselly cousin “what action do I need to take in order to not get sued”. It may seem callous but it’s the reality of modern medicine where answers to a clinical puzzle occasionally present themselves only in retrospect.

I want to give the AZ vaccine to any informed person who wants it, but I and other GPs need to know we can deliver a non-preferred vaccine.

Looking at this omnishambles of a rollout I am not satisfied with a Morrison government “assurance” on anything, let alone that it’s got us covered. The bottleneck to getting AZ into people’s arms is for the government to show us in detail exactly how it plans to help us manage the risk of this new vaccination phase.

Mitchell Squire is a GP and a regular Crikey visual satirist.

Do you agree the Morrison government’s vaccine rollout is an omnishambles? Write to letters@crikey.com.au, and don’t forget to include your full name if you’d like to be considered for publication.