Nicole MacKee writes:
With Australia’s COVID vaccination program woefully behind schedule, Prime Minister Scott Morrison has repeatedly sought to blame the Australian Technical Advisory Group on Immunisation (ATAGI), the body charged with advising the Government on the “medical administration of vaccinations”.
Today, the Prime Minister noted that he had appealed to the expert body to reconsider its vaccination advice.
“It’s a constant appeal, it’s a constant appeal, I can assure you,” Morrison told a press conference, held at The Lodge.
Today’s comments build on several other comments made by the Prime Minister over the past week, including blaming ATAGI for public confusion over vaccination. Earlier this month, Liberal MP Dr Katie Allen revealed on ABC TV that she had written to ATAGI asking members to review their advice restricting AstraZeneca to older Australians.
In April, ATAGI recommended that the Pfizer vaccine should be preferred over the AstraZeneca vaccine in people aged under 50 years, due to concerns about a rare side effect, thrombosis with thrombocytopenia syndrome (TTS). Then, in June, ATAGI revised this recommendation, stating that Pfizer’s was the preferred vaccine in those aged under 60 years, due to concerns about the risk and severity of TTS related to AstraZeneca’s use in the 50-59 year age group.
In revising its advice, ATAGI stated:
ATAGI acknowledges the difficulty in balancing the small risk of a clinically significant adverse event related to vaccination with COVID-19 Vaccine AstraZeneca against the need to protect individuals and the community against the ongoing threat of COVID-19, together with ongoing limitations and uncertainties about the supply of alternative COVID-19 vaccines.
ATAGI emphasises that this advice is specific to the context that there is currently no or limited community transmission in most of Australia and would be different in other countries.”
Morrison’s comments about ATAGI come at a time when misinformation about COVID and vaccinations is being spread via social media, and throughout regional areas, thanks to mining tycoon Clive Palmer’s “anti-vaccination propaganda drive”.
Croakey approached a range of experts and professional bodies to canvass their views on the Prime Minister’s comments on ATAGI.
We asked: How important is it that ATAGI’s independence and expertise is respected at a time of evolving understanding of the risk/benefit equation for COVID-19 vaccines?
Professor Allen Cheng, Co-Chair, Epidemiology, Public Health, ATAGI
ATAGI is an independent expert committee that provides advice to the Minister of Health. Our advice is based on our review of the evolving evidence and by necessity has needed to change as information becomes available.
We have always been conscious of the impact of our recommendations on the program and on confidence in vaccines. The advice we have provided on the benefits and risks of [AstraZeneca] is consistent with the position of many other countries, applied to Australian context.
Professor Stephen Duckett, Director, Health and Aged Care Program, Grattan Institute
It is unfortunate that the PM has attempted to politicise ATAGI by bringing it into the public debate about vaccine strategy to deflect attention from the Government’s poor roll-out performance.
The critical failures that led to Australia’s slow and bungled roll-out were clearly decisions of government: which vaccines would be ordered, and how the roll-out would be managed.
Associate Professor Lesley Russell, Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney, and Croakey contributing editor
ATAGI’s role is to “advise the Minister for Health on the medical administration of vaccines”.
For new vaccines for a new disease with new variants, the risk factors that underpin these decisions are constantly changing.
The Prime Minister (and the Minister for Health) cannot simply abrogate the final responsibilities to act on the advice provided because it isn’t the answer they want – or because the answer changes over time.
Trust in both government and public health authorities are valuable assets in pandemic times, and it should not be undermined by allowing political decisions to override scientific decisions – that leads to a very slippery slope, as we saw in the US under Trump and we are now seeing unfold in the UK under Johnson.
This issue does highlight the importance of effective communications, and clearly the Prime Minister is not the person to provide that.
Dr Tarun Weeramanthri, President, Public Health Association of Australia
Australia is generally very well served by its expert health committees.
ATAGI has been renowned for its technically sound and well-reasoned advice under its previous chair, Terry Nolan, and this has continued under its two current co-chairs, Allen Cheng and Chris Blyth, who have worked in the crucible of COVID-19 and new vaccine developments.
Its previously behind-the-scenes role came to public attention this year when ATAGI changed its advice on the AstraZeneca COVID-19 vaccine when new data and evidence emerged on its side effects profile, and levels of community transmission changed. ATAGI explained each stage of its reasoning and risk analysis publicly.
How such advice best translates into political decisions is a matter for legitimate public discussion. Professor Cheng is quoted in The Guardian as saying that ATAGI’s role is “to provide advice, but the Federal Government remains responsible for making decisions and the vaccination rollout”.
That line between public servant and politician has always been important. The notion that politicians in this COVID-19 pandemic are simply ‘following the health advice’ may have been a useful fiction at the beginning of the pandemic, but it has never really been the case, and should not be the case in our democracy.
Obviously, in the midst of a pandemic, politicians should listen very carefully to the expert health advice, either from a senior official or an expert committee, but politicians must consider other factors and they remain accountable for their decisions.
Currently we hear various commentators debating the advice given in the midst of a crisis. Should young people get this vaccine or another? Should a lockdown be introduced and for how long? Exactly what constitutes an effective lockdown? There are many such questions that are important and rightly influenced by expert analysis and advice.
But we also need to look at the structure and governance of expert health and public health advice as a whole. A few months back I wrote about hotel quarantine and posed a series of questions at three different levels – to National Cabinet, Australian Health Protection Principal Committee (AHPPC) and the Infection Control Expert Group (ICEG). These questions centred around good process, transparency, and how the current system is working to further the national interest.
We need to know more about the structure of health and public health advice going up to National Cabinet, where various committees fit, and which are covered by cabinet-in-confidence provisions and why.
For example, we are waiting on critical modelling advice from the Doherty Institute to inform staged reopening – where and how will that feed into the deliberative process? What non-health, economic and consumer inputs will be factored in, and by whom?
As ATAGI has demonstrated, advice is never perfect, unchanging or wholly guaranteed, but transparency of data and reasoning from individual expert health committees will build trust amidst unavoidable uncertainty.
That transparency should extend to the process and overall system of expert advice, and to its boundaries with political decision-making.
Dr Karen Price, President, Royal Australian College of General Practitioners
ATAGI is Australia’s independent authority on immunisation. It plays a vital role in looking at all of the emerging evidence here and overseas and providing evidence-based advice on all immunisations, including COVID-19 vaccines.
We fully support their role and independence, which is especially critical at this time when vaccination is our pathway to protecting our community and life returning to ‘COVID normal’.
Bruce Levett, CEO, Health Consumers Tasmania
The community is tired of the defensive, argumentative and confusing messages coming from the Federal Government on vaccinations, border quarantine and lockdowns and are searching for trusted information sources to guide their decision-making through a very complex, emotive and difficult time.
What is required is for the Federal Government to work closely with all involved in a transparent and open way, whether it is by releasing the deliberations of its National Cabinet or with those of its expert medical advisors (ATAGI) so that the community can see for themselves the challenges confronting the nation and can have confidence in the decisions being made.
This will allow the Federal Government to rebuild trust and transparency with the community in a way that will allow the community to engage and help lead the vaccination campaign, otherwise, we will further confuse and alienate the community and they will look elsewhere for information they can trust.
Jane Halton, Chair, Coalition for Epidemic Preparedness Innovations
Speaking to ABC’s 7:30 program tonight, Halton said:
“I understand the Prime Minister’s frustration.
“It has been hard to have this sort of nuanced advice from ATAGI easily translated into a message for the community, but let’s boil it down, shall we? There’s some population-wide advice that ATAGI has given, it applies to the broad population, it’s never [been] person-specific advice.”
See Croakey’s archive of stories about COVID-19.
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