ATAGI’s Allen Cheng and Christopher Blyth on how Australia’s vaccination authority lost its anonymity and political innocence

In the pandemic’s first year, it suited political leaders to say they were following the health advice.

By now, the AstraZeneca vaccine had been in use in Australia for a month, but an unforeseen issue had arisen: the jab had been linked to rare, but potentially fatal, blood clots.

With only two local cases of clotting linked to AstraZeneca and no deaths, all eyes were on Britain, which had the longest experience with this vaccine.

With new infections of COVID-19 averaging between 2000 and 3000 a day, Britain announced it would only give the vaccine to people over 30 because anyone younger would be more vulnerable to clots.

Until this point, all ATAGI’s clinical advice had been crafted over months, reviewed multiple times and endorsed by higher levels of government before being documented and presented.

Among them were the secretary of health, Professor Brendan Murphy, and the chief medical officer, Professor Paul Kelly, who would put the government’s position.

Pfizer had outperformed AstraZeneca in clinical trials and people wanted it.

With so many unknowns, Cheng and Blyth kept returning the group to ATAGI’s mandate, which is to focus on the medical implications of vaccines.

And it’s just one of several sources of medical advice the federal government draws on; others include the chief medical officer, the Department of Health and the Australian Health Protection Principal Committee, the peak decision-making body for managing public health emergencies.

The fact that the government took ATAGI’s advice openly and directly, and then applied it in its pure form, reflected the covert power of this quiet expert group.

Instead, they came up with a piece of advice that had two parts and was designed to change as conditions on the ground changed.

If Pfizer was unavailable, it was preferable for people under 50 to have AstraZeneca because the risk of getting COVID-19 was greater than the risk of getting a clot from the vaccine – but they should speak to their doctor first.

A quartet of power composed of Prime Minister Scott Morrison, Health Minister Greg Hunt, Murphy and Kelly relayed the advice to the nation.

“There is not a prohibition on the use of the AstraZeneca vaccine for persons under 50,” he said.

But over the next few days, others got it almost right and many got it wrong, says Associate Professor Nick Coatsworth, a former deputy chief medical officer.

We said our advice would change if the context changed, but perhaps we weren’t explicit about how it would change.”.

But the British health minister, Aneurin Bevan, famously boasted he’d get his way “by stuffing the doctors’ mouths with gold”.

Minister for Health and Aged Care Greg Hunt, Chief Medical Officer Professor Paul Kelly, Secretary of the Department of Health Professor Brendan Murphy and Prime Minister Scott Morrison at a press conference at Parliament House in Canberra on April 8.

Morrison was first in the top 10 for overt power with Murphy third and the Health Minister, Greg Hunt, in sixth place.

ATAGI’s advice would be caught in the commotion.

A source close to him says the original advice had been written in such a way that, once it was received, the government would probably be blamed if a young person died after being given AstraZeneca.

On June 28, after Sydney’s eastern suburbs went into lockdown, he encouraged people under 40 who “wish to get the AstraZeneca vaccine . . .

“The PM was suddenly pushing younger people to GPs who had adopted the hard divide – a literal interpretation of the advice – and who were not ready to give AstraZeneca to this age group.

By encouraging everyone to see their doctor and ask for AstraZeneca, the PM was breaking out of ATAGI’s guardrails, following the letter but not the spirit of its advice and exercising a political preference in a deteriorating situation.

Queensland’s chief health officer, Dr Jeannette Young, was out on the edge, adamant she would not have any “18-year-old in Queensland dying from a clotting illness who, if they got COVID-19, probably wouldn’t die”.

While the ABC characterised his comments as “pouring cold water” on the Prime Minister’s recommendation, Blyth said he was just reinforcing the point that opening the AstraZeneca program to all under 40 was not in keeping with ATAGI’s advice and should only be considered in “pressing” circumstances in this age group.

On July 13, in the context of the growing outbreak, ATAGI reinforced part two of its original advice: people under 60 who did not have immediate access to Pfizer should reassess the benefits of taking AstraZeneca versus the rare risk of clots.

A day later, Morrison openly switched from bowing to the medical advice to blaming it.

In an interview on Nine’s radio network on July 14, Ray Hadley suggested to Morrison that ATAGI’s advice had “been up and down like a fiddler’s elbow”.

“It slowed it considerably, and it put us behind, and we wish that wasn’t the result, but it was.” A week later he told a press conference there had been “a constant appeal” to ATAGI to change its advice on who was eligible for AstraZeneca.

We said from the beginning that our advice would change as the situation changed.“.

Although Cheng had been blooded as deputy chief health officer in Victoria during its second wave and was less affected than other members of ATAGI, he was still bothered.

This reaffirmed its previous advice that in a large outbreak, the benefits of AstraZeneca are greater than the risk of rare side effects for all age groups

For Cheng, there’ll always be tension between operational considerations and health advice that limits those operations

Cheng says much of the friction in this pandemic came from public health belonging to the states and quarantine and vaccination belonging to the federal government