Scott Morrison’s attempt to influence ATAGI’s advice on the AstraZeneca vaccine is misleading
This week Scott Morrison has more or less threatened Australia’s highest advisory body on vaccination, in comments that were at best poorly judged and alarming at worst.
On Wednesday, Morrison said at a news conference that he (or the government) had made a “permanent appeal” to the Australian Technical Advisory Group on Immunization (ATAGI) to review its advice on AstraZeneca on a risk scale.
“You guys simply said the balance of risk is changing, so how does that affect your advice, and it’s time to think about that,” he said Thursday on the radio.
The “guys” (and girls) at ATAGI are clearly just as aware as anyone of the changing risk profile as cases increase.
In fact, ATAGI has already changed its advice on AstraZeneca in light of the outbreak in Sydney.
On July 13, it said that in the event of an outbreak and Pfizer’s supply being restricted, people under age 60 who do not have immediate access to Pfizer should “re-evaluate the benefits to them and their contacts from receiving the COVID-vaccine.” 19 AstraZeneca, versus the rare risk of serious side effects.”
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 her advice on AstraZeneca was very cautious.
He threw a wrench into the vaccination business when he said that Pfizer (of which Australia doesn’t yet have enough) was a favorite of under-50s, then raised the age to under-60.
This was based on the very small risk of blood clots, which are more likely to occur in young adults. The Therapeutic Goods Administration on Thursday announced two more deaths linked to A-Z and strokes — people in their 40s.
ATAGI is not alone
Whether ATAGI was right or wrong in her warning is disputed.
But he is not the only expert source in Australia to take this position.
Research paper by Raina MacIntyre of the Kirby Institute and other authors Published in this month’s issue of the International Vaccine Journal They report a “risk-benefit analysis for Australians aged 18-59”, in which they compared the risk of vaccination from A to Z with the risk of COVID infection.
The authors concluded: “In Australia, the potential risks of the AZD1222 vaccine in younger adults, who are at high risk of death from COVID-19, may outweigh the benefits.”
The article also said: “The recent policy decision to avoid the use of this vaccine in adults under 60 years of age in Australia is fully consistent with previous vaccine risk policy decisions when identifying rare but serious adverse events.”
The authors say their analysis, which was conducted after the death of a 48-year-old woman, “was shared with senior health officials in Australia on 8 April 2021”.
It was the same day ATAGI advised against AZ for those under 50, with the government announcing it at a hastily nightly press conference.
It is up to the government whether it accepts everything ATAGI says – as ATAGI’s jurisdiction indicates, it only “advises”.
Morrison’s back against the wall
Surely we know that ATAGI’s advice (and the debate it has sparked) contributed to a hesitation in vaccines including among those who are suited to AZ – the elderly – which is very unfortunate.
It would be legitimate – if difficult and some would say irresponsible – for Morrison to ever say he thought ATAGI was wrong, other advisers were telling him something else, and so the government rejected ATAGI’s advice.
But what he should not – a leader with his back to the wall due to Pfizer’s shortage and the collapse of the launch – is trying to rely on a supposedly independent group of experts to change its advice.
The prime minister’s goal seemed clear. If ATAGI is flexible, he can say, “This is the new health advice – everyone should follow.” He will 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 view has nothing to do with that change – will it have the same credibility? Wouldn’t a lot of people, suspicious and pessimistic already, think that “it’s just ATAGI under political pressure”?
If the perception of ATAGI independence is undermined, the usefulness of the body – whatever you say – comes into question.
At his press conference Thursday, Morrison tried to recycle his pressure on ATAGI.
He said he fully respected her advice.
“This is why we follow ATAGI’s advice. My job as Prime Minister is not just to accept advice without criticism. Whether it’s in Cabinet meetings or in other forums, of course I challenge the advice I receive. I ask questions. I delve into it. You expect me to do that. I think that Australians would not expect me to simply take this advice at face value.”
In fact, on many occasions, the government has made it a virtue to accept health advice without question.
in the Australian financial audit Two economists, Ashley Craig and Matthew Lilly, criticized ATAGI for not including its recommendations on social benefits versus risks.
They write: “Ask yourself whether ATAGI made the right call by refusing to correctly interpret social benefits in its advice, encouraging millions of Australians to delay vaccination.”
“It’s never too late to change that message. With millions stuck in lockdowns, ATAGI can focus instead on how speeding up vaccinations will make society better off.”
This, however, seems wrong. ATAGI is a narrow advisory body that specializes in immunization. It will not ask the Treasury to evaluate Pfizer’s effectiveness against AstraZeneca. ATAGI’s advice is part of a broader picture, which the government has a duty to bring together in one framework.
Experts in the spotlight
The ATAGI episode is just the latest chapter in the evolving story of health experts’ role in this pandemic.
Early on, their status was largely undisputed. Morrison and other leaders were constantly referring to and ashamed of them.
But then health officials, especially at the state level, became controversial figures, accused of being political.
Although federal bureaucrats were not targeted in the same way as state officials, there was a growing perception that their advice was influenced by the political needs of their masters.
This makes it all the more important that independent advisory groups like ATAGI are not seen as politically motivated.
While Morrison struggled with what he was saying, or not saying, about ATAGI, on Thursday he did what he hates to do, to have the media off his back on another front.
He was under pressure because he earlier refused to say “sorry” for the program’s rollout problems — he resisted word, preferring to say he took responsibility.
But at Thursday’s press conference, he said: “I’m definitely sorry that we weren’t able to achieve the marks we had hoped for at the beginning of this year. Of course I am.”
He has decided, or is convinced, that the “sorry” question will not go away without dealing with it. It can be hard to leave ATAGI questions to rest.
Michelle Grattan is a Professorial Fellow at the University of Canberra and a Principal Policy Correspondent at ConversationWhere this article first appeared.