Question Number: 197
PDR Number: SQ22-000567
Date Submitted: 21/11/2022
Department or Body: Department of Health

Question 175 The role of the Australian Technical Advisory Group on Immunisation (ATAGI) is to advise the Minister for Health and Aged Care on the medical administration of vaccines available in Australia, including COVID-19 vaccines and those available through the National Immunisation Program. Under the Australian Immunisation Register Act 2015 (AIR Act) it is mandatory for all vaccination providers to report all COVID-19 vaccinations administered in Australia to the Australian Immunisation Register (AIR). The ATAGI Clinical Guidance for COVID-19 vaccine providers contains information about contraindications to COVID-19 vaccines, both generally and to the specific vaccines that are currently available in Australia. The medical basis for a medical contraindication to COVID-19 vaccines is based on guidance from the ATAGI.

Currently, there are two valid reasons for reporting a medical contraindication to a COVID-19 vaccine to the AIR. These include: • Anaphylaxis to a vaccine/vaccine component
• Acute major medical illness.

It is important to note that medical contraindications to vaccination are rare. Medical contraindications for COVID-19 vaccines can only be assessed and reported to the AIR by eligible Health professionals, including GPs, paediatricians and infectious disease physicians. Additionally, ATAGI has provided further guidance on medical exemptions to assist vaccination providers, the ATAGI expanded guidance on acute major medical conditions that warrant a temporary medical exemption relevant for COVID-19 vaccines, can be accessed at www.health.gov.au and searching for ‘ATAGI COVID-19 exemptions.’ Whilst the AIR can provide evidence for the medical conditions agreed by ATAGI, states and territories may choose to accept other categories, and other forms of evidence for an exemption to vaccination. While the Government encourages as many Australians to be vaccinated as possible, the Government’s position on COVID-19 vaccination is that it is voluntary, as are all vaccinations in Australia. State and territory public health orders may set mandatory vaccination requirements for certain professions and the limited exemptions that apply. Further information about current public-health orders may be found on state or territory government websites. Question 176 The ATAGI Clinical Guidance for COVID-19 vaccine providers (the Clinical Guidance) contains information about COVID-19 vaccines, both generally and to the specific vaccines that are currently available in Australia. The Clinical Guidance notes that the risk of reinfection with the Omicron variant is very low within the first 3 months following a confirmed infection and all people are recommended to defer COVID-19 vaccination for 3 months after a confirmed SARS-CoV-2 infection. ATAGI notes that natural immunity from past infection may be recognised in several countries overseas, however there are challenges with confirming past infection and uncertainty with regards to the duration of protection. ATAGI advise that vaccination is likely to enhance the protection induced by infection. The interval between infection and vaccination enhances the protection from vaccination by further boosting the immune response, including immune memory response, generated following infection. For people who have been infected and are required to receive COVID-19 vaccination, a temporary medical exemption may be applicable. People should speak with their healthcare provider about what is best for them. Providers are advised to only provide temporary exemptions for a period of up to 4 months after infection. This is due to the increased risk of reinfection after this time. ATAGI continues to review all current and emerging evidence on the use of COVID-19 vaccines, including duration of protection from past SARS-CoV-2 infection, and will provide updated recommendations to the Minister for Health and Aged Care as required. Question 193 ATAGI members’ area of expertise and position is detailed on the Department of Health and Aged Care’s (the department) website at: www.health.gov.au/committees-andgroups/australian-technical-advisory-group-on-immunisation-atagi. Question 194 The department does not hold information on the funding provided by Bill and Melinda Gates Foundation and other pharmaceutical organisations to Australian organisations. Question 195 In order to become a voting member of ATAGI, an expression of interest process is undertaken. A short list is developed by the Australian Government Chief Medical Officer for consideration by the Australian Government Minister for Health across two categories: clinical professionals, researchers and/or service delivery experts, and consumer representatives. ATAGI members are sought based on their in-depth knowledge of vaccines, immunisation and/or service delivery and their expertise in areas such as paediatrics, immunology, infectious diseases (paediatric and adult), public health, immunosuppression in adults, maternal immunisation, and pathology. Researchers bring experience in disciplines supporting the assessment of vaccines and their use in the population, including epidemiology, modelling of infectious diseases, the behavioural factors impacting vaccine uptake, health technology assessment, and systematic reviews of evidence. Immunisation service delivery experts bring experience in General Practice, nurse immunisation, immunisation for Aboriginal and Torres Strait Islander peoples, and immunisation for Culturally and Linguistically Diverse populations. There are 21 members on ATAGI, several of whom hold positions with Monash Health. ATAGI members’ area of expertise and position and the Policies and procedures for the administration and governance of the Australian Technical Advisory Group on Immunisation is available on the department’s website at: www.health.gov.au/committees-andgroups/australian-technical-advisory-group-on-immunisation-atagi Question 210 ATAGI continually reviews and closely monitors reports of all adverse events following COVID-19 immunisation including rare but serious cases of myocarditis and/or pericarditis. ATAGI received the first indications of possible cases of myocarditis following COVID-19 vaccines towards the end June 2021, from reports from the USA and Israel. In response to this, on 1 July 2021 ATAGI experts, together with cardiologists, met to consider all available evidence including data collected by the Therapeutic Goods Administration (TGA) who thoroughly assesses and undertake continual monitoring of safety, quality and effectiveness of all vaccines. The ATAGI Guidance on Myocarditis and Pericarditis following COVID-19 vaccination following COVID-19 vaccination was developed in consultation with cardiologists and other medical experts and published on 2 August 2021. Myocarditis and pericarditis are rare adverse events associated with COVID-19 vaccines and can occur in the general population from a variety of causes. Important to note, not all cases that occur are caused by the vaccine. Most cases are mild, and patients recover quickly. ATAGI continually monitor local and international data on myocarditis and pericarditis and update the myocarditis guidance informed by the best available evidence. Most recently this document was updated on 29 September 2022.

Question 242 The department is unable to verify that quote as coming from A/Professor Nigel Crawford. The link provided from the Melbourne Vaccine Education Centre on Vaccine-associated enhanced disease (VAED) mvec.mcri.edu.au/references/vaccine-associated-enhanceddisease-vaed notes that: “There is no evidence to suggest VAED is associated with the current COVID-19 vaccines. On the contrary, more COVID-19 related morbidity and mortality has been observed in unvaccinated populations globally. Ongoing surveillance and long-term vaccine follow-up will continue.”

Question 288 The department has not been able to locate evidence of reports that students are running hospital wards because of vaccine mandates resulting in staff shortages. Although the Australian Government encourages as many Australians to be vaccinated as possible, the Government’s position on COVID-19 vaccination is that it is voluntary, as are all vaccinations in Australia. State and territory public health orders may set mandatory vaccination requirements for certain professions and the limited exemptions that apply. Further information about current public-health orders may be found on state or territory government websites. The department recognises the significant challenges and increased demand being experienced in our public hospital systems. The Australian Government is working in close collaboration with states and territories on several short and long-term measures to ease pressure on hospitals, including critical interfaces with primary care, aged care and disability as well as workforce strategy and planning. All Australian Health Ministers are also meeting regularly to discuss the performance of Australia’s health system, including the public hospital system.