Scott Morrison has more or less trashed Australia’s highest immunization advisory body this week, with comments that were ill-judged at best and alarming at worst.
Morrison told a news conference on Wednesday that he (or the government) was making a “constant appeal” to the Australian Technical Advisory Group on Immunization (ATAGI) to review its advice on AstraZeneca based on its risk balance.
On Thursday he said on the radio: “I just said the risk balance is changing, guys, so how does that affect your advice, and it’s time to think about that.”
The “boys” (and girls) on ATAGI are clearly as aware as anyone of the changing risk profile as cases mount.
Indeed, ATAGI has already adjusted its advice on AstraZeneca in light of the Sydney outbreak.
On July 13, it said that when there was an outbreak and supply of Pfizer was limited, people under 60 without direct access to Pfizer had to “reassess the benefits to them and their contacts of being vaccinated with the COVID-19 vaccine AstraZeneca, versus the rare risk of a serious side effect”.
ATAGI, whose members have qualifications in immunization and infectious diseases, is tasked with advising the Minister of Health on immunization issues.
There is no doubt that the advice on AstraZeneca has been very cautious.
It threw a spanner in the works when it said Pfizer (of which Australia doesn’t have enough yet) preferred people under 50, then raised the age to under 60.
This was based on the very small risk of blood clots, which are more common in younger people. Two more recent deaths linked to AZ and blood clots were announced Thursday by the Therapeutic Goods Administration — the people were in their 40s.
ATAGI is not alone
Whether ATAGI is right or wrong in its caution is disputed.
But it is not the only expert source in Australia to take this position.
A paper by Raina MacIntyre of the Kirby Institute and other authors, published in this month’s issue of the international journal Vaccine, reported their “risk-benefit analysis for Australians aged 18-59,” comparing the risk of AZ vaccination. with the risk of COVID infection.
The authors concluded: “In Australia, the potential risks of the AZD1222 vaccine in younger adults, who are at low risk of dying from COVID-19, may outweigh the benefits.”
The article also said: “The latest policy decision to avoid the use of this vaccine in adults < 60 years of age in Australia is fully consistent with previous policy decisions on the risks and benefits of vaccines when rare but serious side effects were identified."
The authors say their analysis, done after the death of a 48-year-old woman, “was shared with senior health officials in Australia on April 8, 2021”.
That was the same day that ATAGI advised against AZ for under 50s, which the government announced at a hastily convened late-night press conference.
It is up to the government whether to accept what ATAGI says – as ATAGI’s order states, “advise”.
Morrison’s back is against the wall
We’re sure that ATAGI’s advice (and the debate it provoked) has contributed to vaccine hesitancy, including among those for whom AZ is best suited – older people – and this is very unfortunate.
It would be legitimate – if difficult and some would say irresponsible – for Morrison to say at some point that he thought ATAGI was wrong, that other advisers told him otherwise, and so the government rejected ATAGI’s advice.
But what he – a leader with his back to the wall due to the Pfizer shortage and rollout rubble – should not be trying to rely on a supposedly independent expert group to change his advice.
The prime minister’s aim seemed clear. If ATAGI were pliable, he could say, “This is the new health advice – everyone should follow it”. He would have the best of all worlds.
Or maybe not. If and when ATAGI changes its advice from now on – even if the Prime Minister’s opinion has nothing to do with that change – will it have the same credibility? Won’t many people, who are already suspicious and cynical anyway, think ‘that’s just ATAGI giving in to political pressure’?
If the perception of ATAGI’s independence is undermined, the usefulness of the body – whatever it says – becomes questionable.
At his press conference on Thursday, Morrison tried to increase his pressure on ATAGI again.
He fully respected the advice, he said.
“That is why we followed the advice of ATAGI. It is my job as Prime Minister not to accept just any advice uncritically. Whether in cabinet meetings or in other forums, of course I contest the advice I receive. I ask questions I’m drilling into it. You’d expect me to do that. I don’t think Australians would expect me to just take this advice at face value.”
In fact, on numerous occasions, the government has made a virtue of simply accepting health advice.
In the Australian Financial Review, two economists, Ashley Craig and Matthew Lilley, criticized ATAGI for not incorporating social benefits versus risk into its recommendations.
They write: “Ask yourself whether ATAGI made the right decision by refusing to properly account for social benefits in its advice, which encouraged millions of Australians to delay vaccination.”
“It’s not too late to change this message. With millions stuck in lockdowns, ATAGI could instead emphasize how speeding up vaccinations will make society better.”
However, this seems wrong. ATAGI is a narrow, specialized vaccination advisory body. You wouldn’t ask Treasury to rate Pfizer’s effectiveness against AstraZeneca. ATAGI’s advice is part of a larger whole, which must bring the government together in a single framework.
Experts in the spotlight
The ATAGI episode is just the latest chapter in the evolving story of health experts’ role in this pandemic.
In the beginning, their status was virtually undisputed. Morrison and other leaders constantly referred to them and put them off.
But then health officials, especially at the state level, controversial figures, were accused of being political.
While federal bureaucrats have not been targeted in the same way as state officials, there is a growing perception that their advice is influenced by the political needs of their masters.
This makes it all the more important that independent advisory groups such as ATAGI are not perceived as politically biased.
While Morrison struggled with what he did or didn’t say about ATAGI, he did what he hates on Thursday to get the media off his back on another front.
He’d been under pressure for previously refusing to say “sorry” for the rollout problems — he’d resisted the word, preferring to say he took responsibility.
But at Thursday’s press conference, he said: “I am certainly sorry that we were unable to achieve the points we hoped for at the beginning of this year. Of course I am.”
He had decided, or was convinced, that the ‘sorry’ question would not go away without being addressed. It might be harder to put the ATAGI questions to rest.
Michelle Grattan is a professor at the University of Canberra and chief political correspondent at The Conversation, where this article first appeared.