Professor Allen Cheng (Image: AAP/James Ross)

For much of her long career, consumer health advocate Debra Petrys has worked behind the scenes but this week she has emerged, under pressure, to defend her role in the fateful decision taken by the Australian Technical Advisory Group on Immunisation (ATAGI) in April to recommend Pfizer over AstraZeneca as the preferred vaccine for those 50 and under.

“The decision weighed heavily on me,” Petrys told Crikey. “Did I know it would create vaccine hesitancy? Yes I did. I still think it was the right decision.”

She said this even as Australia’s vaccine rollout falters badly in no small measure due to the trashing of the AstraZeneca brand.

Petrys was one of 15 members of ATAGI. In a group dominated by top-tier medical specialists, nurses and clinical experts, she alone represented the interests of the consumer on behalf of the Consumer Health Forum, the peak body for Australia’s healthcare consumers.

The consequences of its decision also appear to have been reflected in Australian Bureau of Statistics data published this week on the reasons for vaccine hesitancy among older people: 35% of those aged 50 to 69 who haven’t been vaccinated want a different vaccine, and for those over 70 the figure is 26%.

The data does not refer to AstraZeneca as the issue but it’s hard to conclude otherwise.

“It’s very well to look back in hindsight,” Petrys said. “The Delta variant wasn’t around. And you can’t go back and change what’s happened.”

Petrys can only speak because she is no longer part of ATAGI — her term expired in June. Otherwise the public only gets to hear about its deliberations through official channels or its co-chair, Professor Allen Cheng.

Petrys and Cheng have both hit back at Prime Minister Scott Morrison for pointing the finger of blame at the advisory committee. Morrison said ATAGI had been “very cautious” and that this had had “a massive impact” on the vaccine rollout.

Petrys says she’s “a little disappointed” with his comments but has been forced to defend her role because back in April Cheng nominated consumer concerns as the “tipping point” for the AstraZeneca decision. He said it came down to a realisation that the public might struggle to comprehend the risks and benefits posed by AstraZeneca. 

Petrys takes issue with being fingered as the culprit: “It was very much a collective decision and it was taken after days and nights of debating the issues. Everyone has the same opportunity to have a voice.

“From my position as a consumer representative I wanted to be sure that the vaccine was safe. I felt consumers had a right to know the risks and I think we were struggling with how the Australian population would understand the information.

“There was so much information swirling around everywhere. We were looking at confidential international data that the public didn’t know about.”

Petrys stresses that ATAGI is an advisory committee and that the government ultimately makes the decision. Cheng made the same point.

Maybe. Maybe not.

Australian Medical Association president Dr Omar Khorshid tells Crikey that although it was open to the government not to accept the expert advice, in practice it was “very difficult” for a minister to reject it. Morrison’s rationale in an interview with 2GB yesterday was: “Those decisions are made independent of government, and should be. If we want a system where drug control in Australia is not run by politicians but by professional medicos, sometimes that means they’ll be very cautious in circumstances like this.”

Again, maybe. Maybe not.

“What the government could have done was go back to the ATAGI,” Khorshid said. “They could have sat down with the stakeholders and discussed the recommendations, but they didn’t. Part of the problem was the dramatic way it was done, with Scott Morrison going out and making a statement that night.”  

So was ATAGI’s decision on April 8 the right one?

“I was surprised,” he said. “The problem was that the advice they supplied should have been modelled on a big outbreak. There is a question, too, if they adequately considered the community benefit.”

At the time of the decision Cheng put out a long rationale on Twitter. He set out the balancing act between the risk of dying from blood clots from AstraZeneca against the risk of dying from COVID-19 — a complicated equation taking in gender, age and the amount of COVID in the community. In the UK, where COVID was everywhere, the equation meant that AstraZeneca was recommended for anyone over 30. In Australia the threshold was now to be set at 50.

Why?

“In Australia, we don’t have COVID in the community at the moment, but we recognise that the risk of incursion is ever present,” Cheng wrote. “So the balance of the risks and benefits are different. If there was a lot of COVID about, then the benefit in preventing COVID would outweigh the risk for almost all adults, except for very young adults. This is pretty much the situation in the UK at the moment.”

Neither statement has aged well.

Cheng also made much of patients’ rights: “We also carefully used the word ‘prefer’ (Pfizer over AZ) in younger people. We respect patient autonomy — that people have a choice about the vaccines and treatments they get.

“If a younger person said that they were happy to take a one-in-200,000 risk of clotting for the benefit of getting protected from COVID earlier, then as long as this was an informed decision, we should respect that choice.”

But who would easily trust AstraZeneca after that? And all for a blood-clotting risk experts put at 0.0005%.

Chief executive of the Consumer Health Forum Leanne Wells says the forum had faith that ATAGI fully informed itself of all the data and information it needed to give its advice based on the best information at the time.

“As we’ve seen with the Delta strain, the community accepts that the pandemic is an evolving situation and that advice to consumers is likely to change,” she said.

“The issue we need to be assured about is that best efforts are being made to meet consumers’ thirst for clear, unambiguous, consistent and timely information. At present, this appears to be varied across governments and even across the medical community.”