Date published: 
16 April 2021
Media type: 
Transcript
Audience: 
General public

PAUL KELLY:       

So, good afternoon. Paul Kelly here in Canberra, with the daily update on the COVID situation here in Australia. I just want to make a couple of points before I go to questions in the room. And I have a couple of slides to show here as well to illustrate my second point. The first point, there's been a lot of discussion about the unfortunate situation of a 48-year-old woman who passed away in New South Wales. And speculation, I would say, about whether that was related or indeed caused by the vaccination. People should be cautious it's about jumping to conclusions. We do have a very well thought through and very long-standing approach to such matters. The TGA will be- has convened a special expert group to examine the information we have so far that has been gathered from the clinical team that looked after this woman and from New South Wales Health. A lot of information to look through. What are the fact that we know? And they'll be meeting today at 4 o'clock this afternoon. And there will be more information after that meeting, in terms of where they've come to with that conclusion. It is possible they won't make a conclusion today because of the complexity of the case. I am familiar with some of those details, but I am sure people would realise that for privacy reasons it is not appropriate for me to go into those at this time, but all of those- that information will be available to the expert group. They'll look at all that information and put it together. So, it is true that she had the AstraZeneca vaccine a few days before she became ill. Whether those two events are related is a matter for those experts that will be meeting today. And so I won't go into further details about that particular case.

I do, though, want to really address the issue, recognising I am the Chief Medical Officer for Australia, I am one of the key medical advisors to the Government in relation to the matters of the COVID vaccine and the COVID response. So I really want to look at this issue that has been raised about the risks and benefits of the AstraZeneca vaccine. So, I- these are my two slides to illustrate that. Firstly, we do have the advice from the ATAGI group - the group on immunisation, the experts on immunisation - who have made that decision or that advice to Government, which has been accepted by Government, that for people under the age of 50, we should - that they should have a- the- another vaccine other than the AstraZeneca. Because of the risk and benefit equation. As we are, right now, in Australia, and looking at our epidemiology of the disease in Australia. So given that the risk of COVID right now in Australia is low, and this relates to the first slide we have here next to me. So, this is the current scenario. The benefits of the vaccination with AstraZeneca in preventing severe COVID-19 outweigh the harms of this rare but serious event of the thrombocytopenic syndrome in people aged 50 years and over. And so this is based on a scenario of a low level of exposure to COVID-19. So at 29 people per hundred thousand overall in a six-week period, that's the scenario we are thinking about at the moment. So, low transmission in Australia. Again, today was a zero transmission day in Australia, this is- that's the 65th day this year that has been the case. So, when you look at this slide, on one side in the Orange is the risk of getting the clots, and this is these unusual events, these severe central venous thrombosis. And on the other side is the risk of being admitted to an intensive care unit. And so, when you look at that, we know from information we've said here before, that the risk of severe COVID infection increases with age, whereas the risk of the clots decreased with age. And so, ATAGI, looking at that information, chose 50 years of age as the cut off. I'll just go to the next slide now. And this is really important. So this is actually a different scenario, which takes into account where we were in Melbourne, in last winter. So, just over a year ago. Anyone in Melbourne will remember how many cases there were at that time circulating in the community, how many people were in hospital, and in intensive care. This slide demonstrates, using the same parameters on the orange part there on the slide, demonstrating that same risk, that one-off risk of severe clots from the AstraZeneca vaccine. And on the blue side the risk of being admitted to intensive care over a 16-week period. And I think you can really see how that really jumps up in that over 50-year age group. And this is an important concept for us to consider. We are in a very unusual situation here in Australia at the moment, with no community transmission and very few cases right throughout this year. That will not continue. We will at some point in the future - we don't know when - but we will have cases here in Australia. The chances of being infected will increase, and so being vaccinated is a protection not only for yourself, but also for the people you care for. If you're working, for example, in an aged care home or in a hospital, your family, and the wider community. That is why we have a vaccination program. And the benefits of being vaccinated outweighs the risk of these rare events. I'd add one more piece of information. I've read a paper this morning, it's in pre-print, and so it hasn't been peer-reviewed yet. But this morning, demonstrates from information from the US [sic], looking at 500,000 people who had COVID infection, and 500,000 people who hadn't, and comparing the rates of this extremely rare event, this central venous sinus thrombosis, the people who had COVID infection, they were nine times more like we do get this CVST, compared with those rates we now know from the AstraZeneca vaccine. I'll repeat that because it is important. Four people per million have been found in people in Europe and the UK, and we're finding that a similar rate here in Australia, with that CVST, the serious blood clotting event. From- related to AstraZeneca. In this study, they have had a class of some sort related to their COVID disease. So clotting is a feature of COVID. It also happens to be a feature, very rarely, of this AstraZeneca vaccine. But the benefit absolutely, particularly for those over 50, outweighs a sing vacantly the risk found a 36 per million, for people that had the COVID disease. So, having COVID itself is a risk of clotting. That's- for that very rare event. [Audio skip] Other clots, when we look at what's happened with people who have been admitted to hospital through the whole pandemic, they have- 16 per cent of them, 16 per cent of people, have had clots of some sort related to the COVID disease. So clotting is a feature of COVID. It also happens to be a feature, very rarely, of this AstraZeneca vaccine. But the benefit, absolutely, and particularly for those over the age of 50, outweighs significantly the risk of that particular event from the AstraZeneca vaccine.

So, I will finish with one final issue that relates to that. Please, if you are in the 1A or 1B group, that means you are either at higher risk of severe COVID disease or you are a crucial worker looking after people at higher risk of COVID disease. When you have the chance to get your vaccine, please go and get your vaccine. Roll up to your GP or wherever you can get your vaccine provided, have a talk to your vaccine provider if you have concerns, but please do not cancel your appointment. Go and at least have that conversation and take the vaccine, because that's the way we're going to get on top of the COVID situation in Australia. So, I'll go to the room first.

QUESTION: 

It's been one week since the advisory on AstraZeneca. Since then, how many of the vaccinations administered have been AstraZeneca and how many have been Pfizer, and how does that compare to the weeks before advisory?

PAUL KELLY:       

So, I can tell about where we are up to in terms of the vaccinations, and apologies, I don't have the- have it by the actual vaccines, but I can provide that to you-

QUESTION: 

[Interrupts] Will you commit to release that, though? because the Health Minister's office has suggested that's a matter for National Cabinet.

PAUL KELLY:       

So, what I can tell you is that we are now at 1.420 million doses nationally. Primary care, that we know is only using the AstraZeneca vaccine, has now delivered 629,289 vaccines. So that's where we know exactly that that's where that's AstraZeneca, we know that 61 million- sorry, 61,272 doses were given yesterday. And I believe it was over 40,000 of those were in primary care. So that would be the AstraZeneca. What I would say is that it's- we have seen some hesitancy, that there's been some- there certainly has been some indication of that, particularly the state-run clinics. That's- in the state-run clinics, they're mostly looking at vaccinating the healthcare workers; many of those would be under 50. So I would imagine there is hesistancy there. But what I'd say to people again, just please, the most important thing is to remember about that benefit-risk equation. That's at the population level. For your own risk and benefit, you should talk to your trusted medical provider. If that's a GP, go and talk to your GP. If it's one of the clinics run by the states and territories, they will also go through that informed consent process. And it's very important for you to consider your own risk, but also that risk-benefit equation. If I just go to the-

QUESTION: 

[Interrupts] How did ATAGI estimate and weigh that risk of hesitancy before issuing the AstraZeneca advisory? And is the reason hat you're standing here today saying that it's inevitable we'll get COVID in community and that COVID itself causes clotting because you regret the strength of that advisory and the fact that it's increased hesitancy so much?

PAUL KELLY:       

We expected that hesitancy would come and that this is not the only news we've had in relation to side-effects from vaccines through this process. What I would say is that of course that was taken into account. The Australian Technical Advisory Group on Immunisation is an advisory group on immunisation, not just on vaccines. And so they were asked to and certainly did take into account the effects of their advice. But what I would say, very importantly, having been involved with epidemiology, infectious diseases and vaccines for almost my entire career, one of the crucial components about vaccine hesitancy, or the opposite, vaccine certainty, is about understanding and knowing that if there is bad news, it's told. That there is openness from people like myself, the Chief Medical Officer, giving that medical advice and tying that into that informed consent process so that people can make those decisions about risk and benefit. I'll go to the next question.

QUESTION: 

Was this woman who passed away, was she given the AstraZeneca jab after the advice changed? And if so, why?

PAUL KELLY:       

So, my understanding it was about 3 or 4 days before she became unwell, so it would have pretty much coincided with a period. I'm sorry, I don't know the exact date when she was vaccinated. Might go to James Campbell from News Corp on the phone.

QUESTION: 

Sorry. Just going to the deceased woman, can we know- are you able to tell us whether she was a- had any underlying conditions that enabled her to get the jab at this age, or was she- because of her work?

PAUL KELLY:       

I don't have that information in front of me. I do know that she did have several chronic disease issues, but whether that was why she was vaccinated or whether it was because she was a- one of the workers in those categories, I'm sorry, I don't know that information. Next question from [Audio skip] at SBS.

QUESTION: 

Yeah, thanks, Paul. Just to that as well, I don't know if you've got the exact dates on when she got the vaccination and when she passed away, but I also have another question as well, just about Pfizer. We heard from Pfizer's CEO that there might be a possibility that a third dose is needed to ensure full, adequate protection. Will that impact the rollout here in Australia? Has Australia [indistinct]… in terms of its vaccine for that extra dose?

PAUL KELLY:       

So, in terms of the woman that passed away, and I know, I needed to say at the beginning my condolences, of course, to her family at this tragic event. So she died the- earlier this week, and we- it was the next day, which was yesterday, we- from the TGA as well as New South Wales Health put out that advisory. So it was Wednesday night.

In terms of the Pfizer announcement, I've said here before, and I think it's a really important concept for people to realise, that the vaccines that we're rolling out at this stage are the first vaccines in this. They will not likely be the last vaccines that we will have. We- there are many unknowns at the moment in terms of the vaccines. One of them is about the duration of effectiveness. The first- let's think about it. The first ever vaccines that were used in clinical trials, either- and they were the Pfizer vaccine and the Moderna vaccine, shortly after that, the AstraZeneca vaccines, only got started in about April last year. So we're not- we're only just now at the point of one year post the very first vaccines used in Phase 1 clinical trials. So the Phase 3 clinical trial participants are being followed up for one or two or more years, and so we'll get some good information but we're very early in that phase. It may well be, and we don't know yet, particularly with the new types of vaccines, the mRNA and the viral vector vaccine such as AstraZeneca. We know very little about those components. So it's likely that we will know sometime in the next six months to a year whether those boosters to increase the duration of effectiveness of the vaccines will be the required.

The other component that's being talked about is the so-called variants of concern. And it is true that some of the vaccines for some of those variants are showing that their effectiveness is decreased. And so it's possible that we may need to consider different types of vaccines in the future as the virus becomes- varies over time, and that would be very similar to what we face with flu vaccine every year. So it's possible that we may need specific vaccines as boosters against the new variants. I know there are trials currently underway in the US looking at a multivalent vaccine. So, one vaccine to treat them all if you like, so showing different- to cover various variants, and that may be the new booster. There are also trials underway in so-called mix and match vaccine approaches. So, starting with one vaccine and then finishing with another. And we will have those options with AstraZeneca, with Pfizer, and Novavax, for example, if that proves to be a way of approaching it.

And then the final thing I'd say is we have a lot of vaccines that have been ordered, that have been purchased, have been guaranteed by both Pfizer and Novavax to come into the country from overseas sources, as well as with our own locally made AstraZeneca vaccine, to vaccinate the entire Australian population many times over, so we can work through that over time.

Rosie Lewis from The Australian.

QUESTION: 

Just on the opening of the international border and reflecting on what you've just said looking at data on the durability of the vaccine. The Government is waiting to hear advice from you and other medical experts on the transmissibility of the vaccine amongst vaccinated people and the longevity or the durability. You just said it might take six to 12 months to know about the durability, so when will you have enough data to [Indistinct] to advice Government properly on those measures that could lead to a reopening of the international border?

PAUL KELLY:       

So, this is obviously a decision for government, and it's very much front of mind for National Cabinet. And in fact, at the last National Cabinet meeting, the Australian Health Protection Committee, which I chair, was given a very specific task to come back to the next National Cabinet, what was at that time the next National Cabinet meeting in May, with further advice about the health aspects of the reopening of borders.

I think- a couple of things I would say about that. Firstly, we know we are part of a global pandemic and in the last 24 hours, over 800,000 cases were diagnosed around the world. It just demonstrates that there is virus circulating, and likely to be virus circulating throughout the world for quite some time to come. Any change in the way that we deal with people coming across our border, therefore, increases the risk of incursion of cases into the Australian population. And so, they are important and difficult decisions to make.

One of the key elements will be the rollout of the vaccination in Australia, there's no question. We are currently very vulnerable, because essentially we're completely open and all of those COVID-safe measures that have been in place for almost a year now, almost all of those have been removed because we're able to do that. But it does increase the opportunity for the virus to circulate. And whilst we- at the moment, only 5 per cent or so of the adult population of Australia have been vaccinated, we need to continue to increase that and that will continue to increase the protection for Australians.

So that's the sort of information we've been asked to give to National Cabinet, and we will provide that through the AHPPC. That's work that's currently underway. It includes the issues of transmission, it includes the issues of vaccines- variants of concern, and it includes specifically what we see as the possibilities as we get those people that are at highest risk of severe disease vaccinated. In particular, how that changes what we would need to do into the future in terms of public health controls.

So thank you very much-

QUESTION: 

[Interrupts] Can I just take a clarification, Professor Kelly?

PAUL KELLY:       

Yes.

QUESTION: 

Do you expect vaccinated Australians would be able to travel overseas for business or health purposes, as flagged by Scott Morrison yesterday, using a home quarantine system this year?

PAUL KELLY:       

So they are some of the things we've been asked to look at, in terms of the protectiveness of vaccination and also alternatives to quarantine. So I won't pre-empt that advice, nor, indeed, of course, the important decisions that would be made by National Cabinet.

I'll take one more.

QUESTION: 

How many over 50-year-olds have cancelled their appointments to get the AstraZeneca vaccine, and how have vaccine hesitancy rates compared in the under 50s and the over 50s since that advisory was applied?

PAUL KELLY:       

Yep. So I don't have that information. We are- there are a number of surveys we're looking at and they were given to us again yesterday in a forum that I was in. Very useful information, but unfortunately, all of it before the announcement about AstraZeneca. So that's something we'll be charting over time in terms of preference through surveys and so forth in the wider community. We are collecting and looking very closely at who- the opposite of your question: who's actually being vaccinated. Who isn't being vaccinated, I'm not sure that we could actually really get that information.

QUESTION: 

Just one on the Olympics, do you think Olympics athletes should be able to jump the queue and get vaccinated ahead of regular Australians before the Tokyo Games?

PAUL KELLY:       

So, and this will be the last question. So, that matter, as I said earlier, ATAGI has been tasked specifically by Minister Hunt who- that committee is an advisory committee to the Federal Health Minister, and he has tasked them specifically with that question.

QUESTION: 

The partial stats [indistinct]…

PAUL KELLY:       

So thanks very much. I need to go now. I'm sorry.

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