UPDATE – AstraZeneca or Pfizer? Clots, serious illness, hospitalisation and the waiting game. Consider a vaccine mix or go for broke, if the Federal government ever comes to the party with a real choice for all.

People of all ages allegedly who have had no serious blood clotting symptoms of dubious or unknown origin (past or present), not tested positive for, had no past family history of TTS (Thrombocytopenia with Thrombosis Syndrome) or underlying rare autoimmune clotting disorder, may be advised to consider AstraZeneca in the absence of availability or access to Pfizer, than face the highly infectious Delta variant if it is not successfully contained in the community in Australia. The health risks are more prevalent from COVID-19 than AZ itself, we have been clearly told. The difference is of course, avoidance of AZ extinguishes the rare clotting risk altogether from AZ (the choice), but not from the same clotting risks and very serious illness which are far harder to avoid unvaccinated from direct exposure to the Delta variant, if it spreads (an important caveat). In such a scenario, waiting until adequate supplies of Pfizer are available towards the end of the year is a calculated risk. Clearly Pfizer would be a safer and more effective option allegedly for all ages if you had a genuine choice, the TGA (Therapeutic Goods Administration) though sticking with under 60. But if you have been diagnosed with, vulnerable to or troubled by TTS and/or an underlying rare autoimmune clotting disorder, there is little doubt surely, you would be best prioritised for Pfizer regardless of age. So why the Federal government and TGA don’t get this when a GP, specialist haematologist and immunologist do, beggars belief.

People under 60 have been told they now have a choice of AstraZeneca or Pfizer, in truth people under 50 always did. The TGA and Federal Government’s messaging was always ‘preference for Pfizer’ (the wording here is both critical and deceptive). If that was not the case because of how the rollout was organised, then that messaging was a lie. Pfizer is in short supply because the Morrison government failed to order and procure an adequate supply last year, that’s a fact, and now we face the consequences till September when we are ‘promised’ it in ‘more abundance’. It is a promise from Morrison, take it and believe it as you see fit, he has a history of announcements and no delivery.

It is suggested that younger people are more at risk of blood clots from AZ, the figure we are given is 3.1/100,000 for <50yrs compared with 1.8/100,000 for 70+ and 1.4/100,000 for 60-70 or 2.7/100,00 for 50-59. This appears to be based on statistics not causation or medical science.

Examine carefully, not a lot of difference, there is only a 0.4-1.7 people/100,000 variance by age, that’s not even statistically significant. Hardly a reason to be making age the reason for the Federal government splitting AZ and Pfizer at 60yrs or indeed ‘preferencing’ and ‘forcing people down two separate pathways. Good for younger people who are at minimal risk of serious illness or death from Covid-19 maybe, but just so marginal. The TGA’s decision was based on this almost insignificantly small statistic of clotting against the far higher risk of older people to serious illness and/or death if left unvaccinated and exposed to Covid-19. The younger you are the less risk of serious illness and hospitalisation, it is this latter age-related reason that is one of two operant factors here, thus priority of vaccination was always the real issue by age, not which vaccine and/or clotting, the lie. It became an issue only because the Morrison government failed to procure adequate supply of alternative vaccines, putting all our eggs in one basket. It is argued they were not to know at the time last year, but no other OECD country has made this blunder with such blatant disregard to the obvious, hence the cautionary proverb over ‘eggs’ and not the only one ‘faced’ by the Morrison government – It’s basic common sense, risk mediation and planning. Given these facts, there is no doubt in my mind that the TGA’s second operant factor in their decision (not clearly publicly disclosed and little to do with medical science) rather it was about dodgy interpretation of statistics and supply and demand of vaccines, emphasis on supply, specifically the scarcity of imported Pfizer and abundance to be of home-produced AstraZeneca; and they knew this. But the Morrison government, this maladministration has done its level best to suppress this fact over time as ‘gold digger’ Morrison puts out his own unending bluffs and arbitrary advice. The Morrison government has in part mythologised and utterly obfuscated age, clots, health risk and vaccination to the point that too was a bag of lies that sent us all in different directions.

The Morrison government also initially declared that the ‘preferred vaccine’ for people over 50, later changed to 60 was AstraZeneca, the converse of the ‘Pfizer preference’ for under 50. Again, older people were denied access by the government online App and phone booking system to Pfizer by locking them out of the private vaccination centres (hubs) which the government contracted out, but not to GPs or the Public Health system. GPs only had access to AZ and the rollout to GPs was a farce. State Health departments had both, but were directed, coerced or chose to select their limited supplies of Pfizer for health care and frontline staff in group 1A. But why would they do that if both vaccines were equally safe and effective other than the interval period between doses?

People over 70 in Aged Care (group 1A or was it 1B?) were managed also by private companies contracted by the Federal government initially for Pfizer, and look what a mess they made of that. Many still are not vaccinated and now, quietly they get AstraZeneca not Pfizer, no announcement changes over that. So go figure – this messaging of ‘preferencing’ was grand lie to the whole population (under 60 and over). It was a mandated operation carried out in an autocratic almost military fashion; and make no mistake there is a reason why senior military personnel have been involved in the rollout. Draw your own conclusions of course, but I suggest it was to soften the public to military involvement in public affairs now and in the future. There are too few public servants and infrastructure remaining thanks to neoliberal ideology, privatisation, public sector extinction and avoidance of using all but the States’ public health system which they would have banished also if they could have. Involving senior military personnel helped them save face politically, saving the Morrison government’s electoral and collective arses. The rollout bungle was morphed into a rescue effort through the perceived efficiency of a military mission, hence also the operational names being assigned to components and phases of the national rollout, mostly mere thought bubbles – Ad hoc or planned, who knows but certainly not ordained by God or tinkering military generals well beyond their expertise and station?

So back to the beginning, where to from here? Everyone has a legitimate choice and they need to weigh up the risks and waiting times for their preference. Consult your GP of course but do not rely on what the Morrison government or Morrison and Hunt are individually telling you, and few in the mainstream media will give you a true and honest picture, grinding their own axes too – Apart from the ABC’s Dr Norman Swan, he is practically the only sensible one among them; even the AMA (Australian Medical Association) and a bevy of specialists have been all over the shop, probably protecting their institutional research grants and reputations.

It should be noted that the first dose of AstraZeneca and Pfizer provide about 33% protection from the Delta variant according to latest data analysis. But the difference comes in the protection afforded by the 2^nd dose. For AZ you will have to wait 3 months between doses with 33% protection and after your 2^nd dose you will emerge with around 60% protection. For Pfizer you wait 3 weeks following which you can expect 88% protection from the Delta variant and no comparable rare risk of clots whatever figure we choose to run with 1.4-3.1/100,000 (by age separation) or closer to 3-4 in the general population according to Nordic countries, and not so long ago we were told it was far less and rarer… Hmmm!

But this is a statistical phenomenon, we don’t know the true science behind it yet. Now if I were a scientist or betting man, or just an ordinary person who critically examines the evidence and asks relevant questions, my hypothesis would be that the clotting issue is more to do with how the virus and AZ vaccine interact with those who have a predisposition to rare autoimmune clotting disorders and TTS, and less if anything to do with the blunt and deviant crux and instruments of age. The real age factor here is the consequence of exposure to the virus itself, serious illness and hospitalisation, and an ageing or compromised immune system which might deliver the same consequence as those who carry the risk of TTS and related syndromes; not to be confused with more common clotting problems associated with trauma, ischaemia, surgery, pregnancy or contraceptive pill.

Mix and Match or Go for Broke

There is another consideration and option the Morrison government and TGA have not yet floated. In Germany, Canada, Spain and South Korea, and from current research out of the UK, if you have had or choose to go with AZ now rather than wait (there are clear undisputable benefits individually and to the community), choosing Pfizer or Moderna 4-12 weeks later for your second dose, affords almost as much protection from the Delta variant as double vaccination with Pfizer (around 88% cf 60% with AZ alone) and with minimal adverse risk outcomes, and a much better result for the community. At least four countries have already implemented this strategy, alas not Australia and I suspect many more will follow as alternative vaccines become more readily available and/or affordable.

If I were over 70, had significant comorbidities or carried risks of TTS whatever age I be, I’d seriously be considering and advocating this path. If I were young, I’d consider it too – gets me on the ladder earlier like now and mediate the best outcome later on my 2^nd dose. But if you are over 60 and seriously troubled by TTS, then you could go for broke – That is to magically assume let’s say the age of 59 to get past the government App, and if that doesn’t work I fancy a little younger maybe at 49 (I am not sure if they have adjusted the age guillotine yet) – A momentary lapse of memory, a typo perhaps, which you can correct by entering your true date of birth later once you are through to the other side – The Pfizer side; I’m sure we can all remember that!

A younger person with TTS or indeed of any age should in my view be given priority access to an mRNA vaccine like Pfizer and bugger the age guillotine altogether – Simply not relevant in the face of Covid-19 and Delta variant on either safety or efficacy. And of course, these life-saving individual medical considerations should be decided by GPs and patients, not politicians, insensitive policies and IT Apps, the TGA and/or consequence of gross government error, incompetence or negligence – outside your jurisdiction and scope of practice.

Ask yourself what would Morrison have done if he weren’t Prime Minister and don’t be fooled by what he imagines Jesus would say? How old is Morrison anyway? The answer is 53, so how come he got past the door to Pfizer in March, 4 months ago when <50yrs was the magical age we were all told by divine decree we could access Pfizer? Do as I do not as I say.

Whatever people decide right now, whether you are over 60 at higher risk of serious illness from the Delta variant or any age with a ‘very rare’ un/diagnosed autoimmune blood clotting disorder (and you can have blood tests for these) or other potential comorbidities, Pfizer clearly delivers the best protection with least risk, as do other alternatives such as Moderna and Novavax when they become more widely available. The real issue is when will that be and what are the risks in the meantime? For many however AstraZeneca now and a mix and match option later is worth considering. Talk it over with your GP and if still you are not satisfied go for broke.

Transparency, facts and truth are not a hallmark of the Liberals or the Morrison government, and Morrison fudges and lies about everything he touches. The king of tourism and economic geography turning fibs into gold, for himself of course. The pandemic like quarantine, border control, refugees, robodebt, the Indue cashless welfare card, bushfires and global climate change are among the many critical topics in his coal bunker of precious lies. Even other Liberal bimbos like Simon Birmingham, Minister for Finance insist in having their say on public record outside of their ministerial portfolio, blowing off at Labor State premiers on this pandemic and public health, politicising anything that moves, and like Morrison, what the fuck would he know about it!