The B.1.351 (‘South African’) variant is more concerning. Pfizer reports a decrease in the neutralisation efficacy of its vaccine based on an in-vitro study of vaccine-produced antibodies against this variant.29 AstraZeneca reports 10.4% efficacy of its vaccine based on a small population of variant-infected patients (N = 39) in the initial trials.30
Less is known about how the P.1 (‘Brazil’) variant, which was identified in January 2021, will respond to existing vaccines. Some pre-print data suggest it is less amenable to neutralisation by convalescent sera from patients infected with wildtype SARS-CoV-2.31 The implications of this for reinfection or vaccine escape are unclear.31
Media statements from vaccine developers suggest it is possible to re-engineer both the Pfizer and Oxford-AstraZeneca vaccines against future COVID-19 variants.32 However, each new vaccine will require engineering, due process and testing before it is commercially available.
Australia's vaccine roll-out plan
The Federal Government aims for all people in Australia who wish to be vaccinated to have received a COVID-19 vaccine by the end of October 2021. The Pfizer vaccine was the first vaccine available in Australia. The Oxford-AstraZeneca vaccine is now also available and is being manufactured in Australia. The roll-out process and priority groups are outlined in the Figure.33 Phase 1a, which began on 22 February, focuses on vaccinating high-risk people who are most likely to be exposed to COVID-19, such as quarantine and frontline health workers, as well as those most at risk, such as aged care residents.33 Phase 1b, which includes people aged 70 years and over, younger people with underlying medical conditions or Indigenous background, other healthcare workers and critical and high-risk workers, began on 22 March. Phase 2a is currently expected to begin in May.
The individual states and territories collaborated with the Federal Government to decide on vaccine ‘hubs’ in regional and metropolitan areas, capable of storing the Pfizer vaccine for the Phase 1 roll-out. At a state and then local level, these vaccine hubs are co-ordinating the roll-out of thawed vaccine product to vaccine clinics and aged care and disability care facilities.
GPs are integral to the further roll-out process in several ways, from offering vaccinations at their clinics and delivering vaccinations within residential care to facilitating postvaccination care and monitoring of vulnerable patients. Practice administration, especially, will be important for organising and ensuring delivery of the second vaccine dose. Your practice may be contacted to assess its suitability for vaccine delivery. We expect that many of the GP respiratory clinics established during the pandemic will be utilised for vaccine delivery.
Vaccine administration and monitoring
All providers of COVID-19 vaccination are required to complete an online training module (www.health.gov.au/initiatives-and-programs/covid-19-vaccines/covid-19-vaccination-training-program). Informed consent should be obtained before vaccine administration. As with other vaccines, administration of COVID-19 vaccines should be postponed in individuals with an acute severe febrile illness or acute infection. Coadministration of COVID-19 vaccine with other vaccines is not routinely recommended. A minimum 14-day interval is recommended between administration of a COVID-19 vaccine and any other vaccine, including influenza vaccine.10
The COVID-19 vaccine should be administered by intramuscular injection into the deltoid muscle.10 Patients should be kept under close observation for at least 15 minutes afterwards. As with any vaccine, appropriate medical treatment should always be readily available in case of an anaphylactic reaction. For convenience, an appointment for the second vaccine dose can be booked at six or 12 weeks (depending on the vaccine received).